Improving Timeliness and Efficiency of Palliative Care Consults in an Adult ICU

Problem: In an adult intensive care unit (ICU) located in a community hospital, delayed or lack of palliative care (PC) consultations for appropriate patients was identified. Only 12.3% (175/1425) of all admitted ICU patients received a PC consult annually. The method for obtaining PC consults in the unit was inconsistent, leading to missed or delayed opportunities for PC services. Purpose: The goal of this quality improvement project was to implement the use of an evidence-based, nurse-driven screening tool algorithm for all patients admitted to the ICU to assist in recognizing those who would benefit from PC services in a timely and efficient manner. Methods: Education was provided to all staff nurses and providers regarding the PC screening algorithm. The algorithm included bedside nurses screening all patients admitted to the ICU with the evidence-based tool, within 24-hours of arrival to the unit; exclusion criteria were post-operative cardiac surgery patients. The results of the PC screen were discussed with the ICU provider during multidisciplinary rounds. Then the provider made the decision whether to enter an order for a PC consult. Results: 359 patients met criteria and 70.5% (253/359) were screened. Of the patients screened, 37.5% (95/253) screened positive and 53.7% (51/95) received a PC consult. The rate of PC consults for positively screened ICU patient admissions was 20.2% (51/253); the total rate of PC consults for ICU patients during the QI initiative was 23.4% (84/359) including patients who were not screened or who screened negative initially but were later deemed appropriate for PC. Conclusions: Findings suggest that PC education and the use of a nurse-driven PC screening upon admission to the ICU can help facilitate discussion of PC need and increase appropriate PC consult orders for patients who would benefit. This is evident by the 90% (12.3% [175/1425] to 23.4% [84/359]) increase in PC consults from pre-implementation to post-implementation of the QI initiative.