Cleveland Clinic Cancer Center (Taussig) Outcomes
Palliative Care in the Medical Intensive Care Unit
Palliative Care is specialized medical care for individuals with serious illness at any age and any stage of illness. It can be provided alongside curative or life-prolonging therapies. Palliative Care providers seek to improve patient quality of life through symptom management, emotional support, advance care planning, and enhanced communication between patients and their care teams about their individual values, preferences, and care goals in the setting of their illness. These services can be provided in the hospital, outpatient, and home based settings. The Palliative and Supportive Care Department is dedicated to finding innovative ways to deliver high quality palliative services to patients in need.
Research demonstrates that Palliative Care (PC) referral positively impacts quality of care. The Medical Intensive Care Unit (MICU) and PC teams sought to improve identification of patients who may benefit from palliative care consultation and have those consultations occur earlier in the MICU stay. Pro-active screening models have been shown to achieve both aims. The teams chose four triggers for a patient screening process, and this model was applied to all new MICU admissions over a period of 12 consecutive weeks (N = 854). Triggers included: hospital admission from a facility; existing diagnosis of metastatic cancer; DNR/DNI at time of MICU admission; acute cardiac arrest. Positive trigger screens (N = 247) were reported to the MICU team and the decision for palliative consultation was left to the discretion of the MICU team. Implementation of the screening model did effectively increase PC consultation volume, and consults occurred earlier in the MICU stay. Palliative consult within 48 hours of MICU admission was found to reduce hospital and MICU length of stay (LOS).
Impact on Length of Stay for Trigger Positive Patients Based on Palliative Medicine Consult Timing During MICU Admission (N = 247)
Impact of Positive Trigger Screen on Palliative Consult Volume in the MICU (N = 854)
Impact of Positive Trigger Screen on Palliative Consult Timing During MICU Admission (N = 854)