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Palliative Care Screening Tool Implementation in an Intensive Care Unit
Abstract
Problem: In a 24-bed urban community hospital intensive care unit (ICU), the use of palliative care services is underutilized. During the first quarter of 2023, only 20% of patients admitted to the ICU received a palliative care consult and the average time between admission to consultation was greater than 5 days (135 hours). Purpose: To implement an evidence-based Palliative Care Screening Tool (PCST) in the ICU to improve identification of palliative care needs, increase appropriate palliative care consults, and improve time to palliative care consultation. Methods: Bedside nurses were educated on the PCST, which included items related to the patient’s reason for admission, past medical history, functional status, frequent hospital admissions, uncontrolled symptoms, and psychosocial needs. On admission, the admitting nurse completed the PCST and all positive screens were presented to the physician, who decided if a palliative care consult was appropriate. If determined to be appropriate, the physician placed a consult order. Once a palliative care consult order was placed, the patient received a consult according to hospital policy. Results: During the implementation period 318 patients were admitted to the ICU. The total percentage of patients screened within the first 24 hours of admission was 87% (n=277). Seventy-two of 113 patients (64%) who screened positive received a palliative care consult and 67 (93%) received a palliative care consult within 72 hours of admission. Overall the palliative care consult rate increased to 23% and the time from admission to consult decreased to less than 2 days (40 hours). Conclusions: Findings suggest using a PCST to identify patients with unmet palliative care needs leads to earlier palliative care consults and increases palliative care consult rates.Identifier to cite or link to this item
http://hdl.handle.net/10713/22819Collections
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