Palliative Needs Screening in a Surgical Intensive Care Unit

Abstract

Problem: A surgical intensive care unit (SICU) at a large academic medical center did not have a process to identify patients with palliative needs. Published evidence demonstrates that screening criteria can help identify those with unmet palliative care needs and increase the rate of appropriate consultations. Purpose: To implement a screening process for identification of unmet palliative care needs among Acute Care Emergency Surgery (ACES) patients in the SICU. Methods: Once the process was developed using available evidence and a validated screening tool, staff were educated on the protocol. The goal was for all admitted ACES patients to receive palliative needs screening by the bedside nurse within 48 hours of admission. For positively screened patients, a palliative care consult would be placed by the SICU provider following approval from the ACES team. ACES patients were re-screened weekly while they remained in the SICU. Results: There were 34 patients admitted during the project period. The total percentage of patients that received screening within 48 hours of admission was 70.6% (24 out of 34 admitted patients). The total percentage of eligible patients that received weekly re-screening was 82% (23 out of 28 eligible patients). The total percentage of positively screened patients that received consultation was 53.8% (7 consults out of 13 positively screened patients). The overall palliative consult rate was 20.6% (7 consults out of 34 total patients). This is greater than the anecdotal baseline of 10%. Conclusions: Barriers were met during the project that affected screening compliance, but the screening tool identified many patients with palliative care needs. While SICU providers were receptive to hearing positive screening results, consultation was deferred at times. But the project may have prompted earlier discussions regarding palliative involvement. With modifications, future initiatives to screen for unmet palliative needs could be extended to other surgical patients in the SICU.