Obinna Ome Irondi
George Washington University School of Medicine & Health Sciences
Arlington
Disclosure information not submitted.
Philip Dela Cruz, n/a
Resident Physician
UHS SoCal MEC Internal Medicine Residency, United States
Disclosure information not submitted.
Erin Jackson, MD
Assistant professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Danielle Davison, MD
Associate Professor of Anesthesiology and Critical Care Medicine and of Medicine
George Washington University Medical Center, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Erica Schockett, MD
Assistant Professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Title: Embracing Palliative Measures in the ICU: Do We Need More Practice?
Background: Implementing palliative care in the inpatient setting improves patients’ symptom management, quality of life, and reduces length of stay in the ICU. Incorporating discussion of palliative domains any provider can assess could increase overall quality of care in the ICU. The study’s objective was to identify the frequency of verbally discussed primary palliative care domains during rounds in an academic ICU setting.
Methods: This was a blinded prospective observational study in an urban academic closed mixed ICU from January-June 2021. An independent observer joined multidisciplinary rounds to log verbal communication of palliative domains for each patient, based on proposed quality measures from the Robert Wood Johnson Critical Care Workgroup. Domains included patient and family-centered decision making, communication within the team and with the patient and family, and symptom management and comfort care. Palliative care topics tracked during rounds using a blinded survey were advance directives, patient’s goals of care, conversations with patient’s family within the past 24 hours, plans for future conversations with the family, surrogate decision maker, presence and plan for pain, as well as presence and plan for respiratory distress.
Results: 434 patient presentations were assessed during the study period. Decision-making capacity was discussed among 72% of capable patients (174 out of 242). Presence of an advanced directive was discussed on 8.5% of patients (N=37). Goals of care reviewed in 11.5% (N=50). Mention of recent conversation with family members occurred in 31% (N=135). Discussion of pain was variable; pain level was discussed among 28% (N=125) and plans for management discussed 59% (N=258) of the time. Plans for future family meetings were discussed with 15% (N=65). In contrast, presence and plan of respiratory distress was discussed 97% (N=421) and 96% (N=418) of the time respectively.
Conclusion: Excluding decision-making capacity, symptom management (pain and respiratory distress) was overrepresented among palliative domains. A gap in application remains despite previously demonstrated benefits of integrating palliative domains. Increased efforts to bolster knowledge and verbal discussion of these additional primary palliative care topics can potentially close the practice discrepancy.