Decreasing Time to Palliative Care Consultation in an Intensive Care Unit

Abstract

Problem: A significant problem for patients in the intensive care unit (ICU) is that palliative care is not involved early in the patient stay. By implementing a screening tool to identify palliative care needs within 72 hours of admission, patient’s palliative care needs can be addressed early in ICU stay. Purpose: The purpose of this quality improvement (QI) project is to implement and evaluate a screening tool to identify patients with palliative care needs in a community ICU to decrease time to referral to palliative care. Methods: The Palliative Care Screening Tool was developed using verified and validated criteria and implemented into practice in a community ICU over a twelve-week period from September 2020 to December 2020. A distribution and collection center for the completed screening tools was created and education occurred for the nurse practitioners on the implementation team and ICU nursing staff regarding the project. Electronic medical record chart audits were completed weekly; data was collected from completed screening tools as well as electronic chart reviews. Screening tool users were surveyed at the completion of this QI project. Results: A total of 193 patients were admitted to the ICU during the implementation phase. Of the patients admitted with a length of stay greater than 72 hours (n=115), 89.6% (n=103) were screened with the tool, and 10.4% (n=12) were not screened. Fifty-five percent of patients screened (n=57) were identified as having palliative care needs. Of those with needs, 50.9% (n=29) were referred to palliative care. Over a 12-week period, there was a decrease in time from ICU admission to referral to palliative care by 68.9%, from 3.95 days at baseline to 2.72 days with the use of a screening tool. Conclusion: The use of a screening tool to assess patient needs for palliative care early in the ICU admission can standardize the process for patient referral and ensure early referral to palliative care.