Palliative Needs Screening Tool In A Neurocritical Care Unit

Abstract

Background: A problem for seriously ill-hospitalized patients is that palliative care conversations are not considered early in hospital stays. Early effective provider-patient palliative care discussions are associated with decreased length of stay, earlier hospice referrals, and decreased use of nonbeneficial life sustaining therapies. Despite the prevalence of pilot studies, few studies focus on patients with neurocritical illness. Prediction tools used in the neurocritical care unit are specific to a diagnosis and help identify illness outcomes and mortality risk in patients. When compared to non-neuro units, neuro-patients had similar palliative care triggers. Local Problem: At a large academic medical center palliative care screening is not completed early in the patient’s admission to a neurocritical care unit using a validated palliative needs screening tool. Interventions: This quality-improvement project assessed if the palliative needs screening tool can be used to identify unmet palliative needs in a neurocritical care unit. A five-criteria screening tool has been validated in multiple intensive care units in patients with similar palliative care needs to neurocritical care patients. A palliative needs screening tool can be used to identify patients with unmet palliative care needs early in a hospital stay. All patients admitted to the 10-bed east side of the neurocritical care unit will be screened within 48 hours of admission. Results: The sample size was 62 patients over the six-week implementation period. Few patients were identified with unmet palliative care needs using the palliative needs screening tool. Data indicates that this screening tool does not identify patients within a neuro-population that would benefit from a palliative care consultation. Advance practice providers completed a palliative needs questionnaire on admitted patients to evaluate for anticipated palliative care needs for this population. Advance practice providers identified that in 69% of cases goals of care were not identified and 54% of the time there were specific social and support needs that the families or patients needed. Distressing physical and/or psychological symptoms were an identified need in 57% of patients screened with the anticipated palliative need questionnaire. Conclusions: The palliative needs screening tool does not identify neurocritical patients who are at risk of unmet palliative care needs. It is unclear if all neuro-intensive care units from previous studies were also patients admitted to trauma-neurocritical care unit similar to the unit used in this project. Despite a lack of positive screening with the palliative needs screening tool, providers were thinking about palliative care needs their patients may have, though no screening or data collection was done for this specifically. This project highlights the need for a specific palliative needs screening tool for the neuro-critical population. A screening tool specific to neurocritical patients will need to be developed that focuses on common palliative needs in a neuro-critical intensive care unit.