Integrating palliative medicine and critical care in a community hospital

Abstract

Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. An ambassador program and expanded visiting hours turned the waiting room into part of the therapeutic environment. New palliative order sets and practice guidelines were introduced. Interdisciplinary care planning was guided by a family communication record. Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.

Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients

“…These deaths occur most often after shifts in patients' care goals and decisions to withdraw life-sustaining treatment (14). There is a growing body of literature describing innovative approaches to and endorsements of the integration of palliative and intensive care (15)(16)(17)(18)(19)(20)(21). However, PC providers have been urged to identify measurable outcomes of such changes in care delivery, and more research is needed (22)(23)(24)(25)(26).…”

Good care for patients who die in intensive care units in Spain. A study based on international care quality indicators

“…Estudios previos han demostrado como resultados la reducción de conflictos y la mejora en la satisfacción del personal de UCI y familiares, sin incrementarse la mortalidad con un uso eficiente de recursos 11 . En el momento actual, estos indicadores, y las actuaciones acompañantes, se ofrecen como una meta a alcanzar, y ya se utilizan como referencia para evaluar y guiar proyectos de mejora en UCI concretas 12 .…”