Impact of a Comprehensive Palliative Quality Improvement Initiative (ICU-PAL) in a Medical-Surgical Intensive Care Unit.

Abstract

Background: Early palliative care practice implementation in the intensive care unit (ICU) improves advance care planning, promotes patient and family satisfaction, and decreases health care costs. The consensus for protocolized palliative care delivery is unknown. We assessed the impact of a qualitive improvement educational intervention that promotes the identification of critically ill patients who will benefit from early expert palliative care interventions.

Methods: In this observational study, we examined the impact of an educational intervention that promoted (1) early detection of palliative care triggers (PCT) during ICU multidisciplinary rounds (MDRs), (2) admission and 48-hour pain assessment, and (3) family meetings within the first 72 hours of ICU admission among critically-ill patients in a mixed adult community ICU. The primary outcome was the monthly number of hospital-wide palliative care consultations pre- and post-intervention. Secondary outcomes included trends in the rate of PCT detection by the MDR team, pain assessment, and family meetings within 72 hours in ICU patients after the implementation of the education intervention.

Results: The median monthly palliative care consultations progressively increased after the ICU-PAL implementation (preceding year: median 49 [45.5-54], first year: 70 [57.25-78.5], second year: 90 [79-105.25], P < .05 for all comparisons). Family meeting documentation within 72 hours among critically ill patients progressively became more frequent after implementation without changes in PCT detection in MDRs nor pain assessment frequency.

Conclusion: Implementing the ICU-PAL qualitive improvement initiative was associated with a consistent increase in the median average hospital-wide palliative care consultations over several years and a progressively increased rate of early family meetings in critically ill patients after its deployment.