Implementation of an Interdisciplinary Palliative Care Trigger Tool on Neurotrauma Critical Care

Abstract

Problem: A Neurotrauma Critical Care unit at an urban academic medical center lacks a reliable process for assessing and managing palliative care (PC) needs. Between the months of July 2022 and January 2023, no patients were screened for PC, and only 3.3% received a consultation. Published evidence demonstrates that a comprehensive assessment of PC needs using a straightforward and objective screening tool identifies patients eligible for PC and supports clinical decisions that prompt PC referral. Purpose: This project aims to evaluate the implementation of a standardized PC trigger tool to address low PC consultation rates. The project is expected to standardize the PC screening process, increase screens, and improve the PC consultation rate for patients at risk for unmet PC needs. Methods: Standardization of PC trigger tool utilization was implemented over a 14-week period in the fall of 2023. In the months preceding the project, an interdisciplinary team of stakeholders was mobilized and received formal training in the utilization of the PC trigger tool and qualifying triggers. Consideration for PC screening was conducted during daily rounds. For patients who screened positive, the managing clinical team consulted PC. Data were collected through weekly chart and unit whiteboard audits. Run charts were utilized to analyze trends in implementation. Weekly staff interviews were utilized to evaluate barriers encountered during the implementation process. Results: After 14 weeks, a total of 33 patients were eligible for screening. There was a 96% compliance rate with screening appropriate patients. Of the patients who were screened, 24 (72%) were eligible for a PC consultation. Of those eligible, 13 (54%) patients had a PC consultation ordered. Conclusions: Data gathered from this quality improvement project suggests that the implementation of a standardized trigger tool can promote PC screening and increase PC consultation rates.