Aunie Danyalian
Pulmonary and Critical Care Fellow
Aventura Hospital and Medical Centre
Aventura, Florida
Disclosure information not submitted.
Michele Iguina
Fellow
Aventura Hospital and Medical Center
Aventura, Florida
Disclosure information not submitted.
Umair Shaikh, MD
Physician
Aventura Medical Center, United States
Disclosure information not submitted.
Sanaz Kashan, MD, FAAHPM
Hopsice and Palliative Care Fellowship PD
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Mauricio Danckers, MD, FCCP
Pulmonary Medicine and Critical Care Fellowship Faculty
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Title: Implementation of a Palliative Quality Improvement Initiative in the ICU (ICU-PAL)
Introduction: Proactive integration of palliative care (PC) practices in the ICU are known to improve quality of life and outcomes for patients. The aim of this study was to evaluate the clinical impact of an ICU-PC quality improvement initiative (ICU-PAL) in the performance of PC triggers detection during multidisciplinary rounds (MDR), pain assessment at ICU admission, and family meetings within 72 hours of ICU admission.
Methods: This prospective intervention was conducted in a 44-bed adult combined open medical, surgical, cardiac, and neuro ICU located in a community-based hospital in Aventura, Florida. Eleven PC triggers were used as a screening tool during MDR to identify appropriate patients. ICU-PAL consisted of 3 phases: educational, observational, and clinical outcomes phase. Patients were analyzed based on the presence or absence of PC triggers. Data collected included patient demographics, ICU resource utilization, ICU and hospital length of stay, pain assessments, and presence or absence of family meetings within 72 hours. Statistical methods included t-test for parametric variables and Mann-Whitney U test for non-parametric variables. We considered a two-sided P value of less than 0.05 to indicate statistical significance with 95% confidence intervals.
Results: Of 388 ICU patients admitted, 189 patients (48.7%) had at least one PC trigger and 199 (51.35%) did not. MDR identified the presence of PC triggers in 142 (90.4%) patients and classified 15 (9.6%) patients having PC triggers when they did not. There were statistically significant differences in PC consultation, change to DNR status, palliative extubation, and comfort care measures in the trigger-detected group (all p< 0.05). There was no statistical difference in pain assessment or score between the first and second half of the study. Of 257 patients with an ICU admission of 72 hours or more,194 (75.5%) had a family meeting within 72 hours. This cohort exhibited a higher pain assessment, APACHE score, change to DNR status, palliative extubation, comfort care measures, and mortality (all p< 0.05).
Conclusion: Implementation of ICU-PAL showed PC trigger screening during MDR assisted in detecting patients who would benefit from a PC approach. There was no statistical difference in pain assessments and family meetings within 72 hours.