Improving Timeliness of Palliative Care Referrals Within the ICU: A Quality Improvement Project.

BACKGROUND

The ICU often provides aggressive treatments that may be futile for critically ill patients. Palliative care (PC) aims to enhance the quality of life for patients with life-threatening illnesses. Despite recommendations for early PC consultations, delays remain prevalent worldwide.

OBJECTIVE

This project aimed to improve the timeliness of PC referrals in a New York City hospital ICU through the implementation of a nurse-driven PC screening tool.

METHODS

Using the Model for Improvement, this quality improvement project was conducted over 7 months, including a 4-month baseline phase and a 3-month implementation phase. ICU nurses used a PC screening tool to evaluate patients within 48 hours of admission. The project aimed to increase PC screenings to 75% and ensure PC referrals within 48 hours.

RESULTS

The implementation phase saw a significant increase in PC screenings, with compliance reaching 90.9% after process adjustments. The average time to PC referral decreased from 8.9 days pre-intervention to <2 days in the 3-month implementation phase. Of the patients receiving PC consultations, 46.6% had do not resuscitate and/or intubate status established, and 20% transitioned to hospice or comfort care.

CONCLUSIONS

The nurse-driven PC screening tool effectively improved the timeliness of PC referrals, demonstrating the importance of standardized screening processes in the ICU.