Palliative Needs Screening Initiative within a Cardiac Care Unit

Abstract

Problem & Purpose: Early palliative care detection and consultation is correlated with increased cohesion between a patient’s wishes and their medical treatment as well as decreased length of stay, moral distress, and burnout in healthcare staff. Despite these benefits, the palliative care discipline is chronically underutilized in critical care settings such as the Cardiac Care Unit (CCU) of a large urban medical center. The purpose of this quality improvement (QI) project is to increase early detection and consultation for adult cardiac patients with palliative care needs using a nurse driven palliative needs screening tool (PNST). Methods: This QI project took place over a 15-week period. Throughout the implementation phase, patients admitted to the CCU were screened by the bedside nurse for palliative care needs using a validated screening tool (PNST). Patients with a positive screen would be addressed during daily interdisciplinary rounds. Completed screening tools were reviewed weekly to determine completion, and accuracy. Results: 133 patients were admitted to the Cardiac Care Unit over the fifteen weeks of QI implementation. Compliance with the PNST system ranged from 35-100% per week with an overall average of 64%. Percentage of positive PNST screenings ranged from 16-71% per week with an overall average of 52%. When compared to pre-implementation, global palliative consult rates increased from 30% to 33%. Conclusion: Analysis of results shows that screening for palliative care needs, and life-limiting illness was able to increase palliative consultation despite seasonal variations in cardiopulmonary exacerbations causing increased patient acuity and its effect on staffing resources as well as contextual elements such as unclear patient identification and provider preferences.