Estimates of the Need for Palliative Care Consultation across United States Intensive Care Units Using a Trigger-based Model

Hua, May; Li, Guohua; Blinderman, Craig D.; Wunsch, Hannah

doi:10.1164/rccm.201307-1229oc

Cited by 164 publications

(143 citation statements)

References 51 publications

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“…3,4,8,46,47 Prior work emphasizes the importance of care provision by clinicians with expertise in palliative care, 47 yet palliative care consultation services cannot see all seriously ill ICU patients. 48 For example, only 36% of patients discussed on our rounds received a palliative care service consultation. We provided bedside nurses with the core skills that palliative care consultants use to navigate discussions of prognosis and goals of care and coached them as they incorporated these skills in practice.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Anderson¹,

Puntillo²,

Cimino³

et al. 2017

Am J Crit Care

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Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

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Section: Discussionmentioning

confidence: 99%

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Anderson¹,

Puntillo²,

Cimino³

et al. 2017

Am J Crit Care

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“…Although the "right" penetration level has not been determined, 3.4 percent is likely below the need for consultation among hospital patients. One recent study estimated that 13.8 percent of intensive care unit admissions met criteria for palliative care consultation, 23 and a study in a large cancer center estimated that one-third of hospitalized cancer patients should receive a palliative care consultation. 24 In addition, we found that one-third of palliative care programs did not have recommended coverage-personnel available on site during weekday business hours and by telephone at all times.…”

Section: Discussionmentioning

confidence: 99%

“…These can be administered by multiple types of hospital personnel, streamline the referral process, and reduce the odds that patients' needs are missed. 23,24,34 Managers should ensure that their palliative care programs collaborate with other related hospital programs such as advance care planning, case management, and pain services.…”

Section: Discussionmentioning

confidence: 99%

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

et al. 2016

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The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.

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“…To meet the PC needs of patients with critical disease in ICU and their families, there must be personnel specialised in the field of PC, with sufficient knowledge and skills. In this approach, the ICU clinicians request PC consultations from PC specialists, but it has been reported that the requirement of PC consultation by ICU clinicians or acceptance of the need could take more time [37]. It could be useful for the PC consultants to participate in the ICU daily patient visits in respect of showing regular collaboration and benefits.…”

Section: Consultative Modelmentioning

confidence: 99%

“…According to this Project, the situations requiring PC consultation are given under five headings [27,37]. …”

Section: Consultative Modelmentioning

confidence: 99%

Palliative care and intensive care integration

Kahveci¹

2017

Med-Science

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With developments in technology and in healthcare policies in Turkey, both the quality and number of applications of care have increased in recent years in intensive care units. At the same time, rates of hospital mortality have increased due to the rise in the elderly population, changes in family structure, increased urban population and easier access to health facilities. Intensive care units are the places where deaths and functional and cognitive disorders are most frequently seen. Current models where intensive care and palliative care are integrated are seen as an important component of comprehensive care for patients with critical disease and who are receiving aggressive intensive care treatment. The goal in intensive care and palliative care integration is to promote better quality, lower cost, patient and family satisfaction. The aim of this review was to highlight the importance and necessity of palliative care applications in intensive care units. It can be concluded that an increase in palliative care training, legal regulations made related to end-of-life patient care and the implementation of palliative care in intensive care unit would provide more effective use of intensive care units.

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Estimates of the Need for Palliative Care Consultation across United States Intensive Care Units Using a Trigger-based Model

Cited by 164 publications

References 51 publications

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

Palliative care and intensive care integration

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