The challenges of establishing a palliative care collaboration with the intensive care unit: How we did it? A prospective observational study

Abstract

Abstract Background Palliative care should be an integral component of comprehensive ICU care for all critically ill patients. Objectives We aimed to study and describe the impact of an ICU-Palliative Care Collaboration using a ICU screening criteria and its influence on referral rates and outcomes. Methods This was a prospective, observational study that included all critically ill patients who were referred to our ICU-Palliative Care Service over a 3-year period from January 2016 to December 2018 in a 1500-bed teaching hospital. Critically ill patients who met the referral criteria would be referred to our ICU-Palliative Care Service. Results A total of 662 critically ill patients were referred during the study period. 398(60.1%) patients had withdrawal of ventilator.595(89.9%) of 662 patients referred to palliative care died. 284(42.9%) patients died in the ICU. The palliative care team continued to care for the remaining 378 patients who were transferred out of the ICU to the general ward. Conclusions Our ICU-Palliative Care service provided care for critically ill patients with palliative care needs in a seamless and holistic manner in both the ICU and post-ICU settings. The establishment of a screening criteria allowed patients with potentially unmet palliative care needs to be identified and referred to palliative care. Active screening and collaborative efforts between the ICU and palliative care team resulted a significant increment in referral rates.