Palliative Care Screening Tool Implementation in a Medical Intensive Care Unit

Abstract

Problem: Palliative care is underutilized and not prioritized in a large metropolitan teaching hospital medical intensive care unit. On average, it takes 6.7 days for a patient to receive a palliative care consultation but can take as long as 49 days. Only 15.74% of patients admitted to the medical intensive care unit will receive a palliative care consult. There is not a consistent method by which palliative care recommendations are made or how patients in need of palliative care services are identified in this medical intensive care unit which contributes to a delay in, or lack of, palliative care. Purpose: The purpose of this quality improvement project is to implement and evaluate the effectiveness of a palliative care screening tool in a medical intensive care unit. Methods: A validated palliative care screening tool was added to the admission documentation in a 19-bed medical intensive care unit to be completed by the nursing staff on each admission. When completed, a total score of 4 or greater creates a task for the nurse via the electronic health record to notify the provider of unmet palliative care needs. Results: Nurses utilized the screening tool 74% of the time. The number of palliative care consults increased from 15.74% to 23.75%. Time from admission to palliative care consult decreased from 6.68 days to 6.25 days. Conclusions: The implementation of a palliative care screening tool was associated with decreased time to palliative care consult and an increase in number of palliative care consults in a medical intensive care unit.