scholarly journals A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit

2020 ◽  
Vol 29 (1) ◽  
pp. 49-61
Author(s):  
Carol L. Pavlish ◽  
Joan Henriksen ◽  
Katherine Brown-Saltzman ◽  
Ellen M. Robinson ◽  
Umme Shefa Warda ◽  
...  
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Social Work ◽  
Care Quality ◽  
Post Intervention ◽  
Goals Of Care ◽  
Icu Length Of Stay ◽  
Early Action ◽  
Family Conference ◽  
Ethical Conflicts

Background Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. Objective To investigate the effectiveness of a proactive, team-based ethics protocol used routinely to discuss ethics-related concerns, goals of care, and additional supports for patients and families. Methods In a pre-post intervention study in 6 intensive care units (ICUs) at 3 academic medical centers, the electronic medical records of 1649 patients representing 1712 ICU admissions were studied. Number and timing of family conferences, code discussions with the patient or surrogate, and ethics consultations; palliative care, social work, and chaplain referrals; and ICU length of stay were measured. Preintervention outcomes were compared with outcomes 3 and 6 months after the intervention via multivariate logistic regression controlled for patient variables. Results The odds of receiving a family conference and a chaplain visit were significantly higher after the intervention than at baseline. The number of palliative care consultations and code discussions increased slightly at 3 and 6 months. Social work consultations increased only at 6 months. Ethics consultations increased at both postintervention time points. Length of ICU stay did not change. Conclusions When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.

Quality Improvement Initiatives to Reduce Mortality: An Opportunity to Engage Palliative Care and Improve Advance Care Planning

2018 ◽  
Vol 36 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Signe Peterson Flieger ◽  
Erica Spatz ◽  
Emily J. Cherlin ◽  
Leslie A. Curry
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
End Of Life ◽  
Advance Care Planning ◽  
Secondary Analysis ◽  
Care Quality ◽  
Care Planning ◽  
Goals Of Care ◽  
Patient Goals ◽  
Advance Care

Background: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. Objective: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning. Methods: We performed a secondary analysis of qualitative data collected through the Leadership Saves Lives initiative between 2014 and 2016. Data included in-depth interviews with hospital executives, clinicians, administrators, and quality improvement staff (n = 28) from 5 hospitals participating in the Mayo Clinic Care Network. Focused analysis examined emergent themes related to end-of-life experiences, including palliative care and advance care planning. Results: Participants described challenges related to palliative care and advance care planning in the AMI context, including intervention decisions during an acute event, delivering care aligned with patient and family preferences, and the culture around palliative care and hospice. Participants proposed strategies for addressing such challenges in the context of improving AMI quality outcomes. Conclusions: Clinicians who participated in an initiative to reduce AMI mortality highlighted the challenges associated with decision-making regarding interventions, systems for documenting patient goals of care, and broader engagement with palliative care. Quality improvement initiatives focused on mortality may offer a meaningful and feasible opportunity for engaging palliative care. Primary palliative care training is needed to improve discussions about patient and family goals of care near the end of life.

scholarly journals Improving Social Work in Intensive Care Unit Palliative Care: Results of a Quality Improvement Intervention

2010 ◽  
Vol 13 (3) ◽  
pp. 297-304 ◽  
Author(s):  
Andrew J. McCormick ◽  
J. Randall Curtis ◽  
Patti Stowell-Weiss ◽  
Carol Toms ◽  
Ruth Engelberg
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
Social Work ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

Palliative Care and Psychosocial Contributions in the ICU

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 481-490 ◽  
Author(s):  
Matthew J. Loscalzo
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Family Care ◽  
Health Care Team ◽  
Care Team ◽  
Social Emotional ◽  
Open Communication ◽  
Goals Of Care ◽  
Family Conference ◽  
The Family

AbstractPsychosocial domains and palliative care medicine are the connective tissue of our fragmented health care system. The psychosocial domains of palliative care are central to creating new partnerships with physicians, patients, and their caregivers in emotionally charged medical environments, especially Intensive Care Units. Managing the psychological, social, emotional, spiritual, practical and existential reactions of patients and their loved ones supports effective action and problem-solving. Practical aspects to establishing realistic goals of care among the health care team and other specialists, communicating effectively with patients and families in crisis, using the diverse and ambiguous emotional responses of patients, families, faculty and staff therapeutically, and helping to create meaning in the experience is essential to whole-patient and family care centered. The family conference is an excellent vehicle to create an environment of honest and open communication focused on mobilizing the resources of the patient, family and health care team toward a mutually agreed upon plan of action resulting in clearly defined goals of care.

Characteristics and outcomes of palliative care patients in intensive care unit.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 145-145
Author(s):  
Renata R. L. Fumis ◽  
Otavio Tavares Ranzani ◽  
Paulo Sergio Martins ◽  
Guilherme De Paula Pinto Schettino
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Icu Mortality ◽  
Icu Stay ◽  
Icu Length Of Stay ◽  
Icu Discharge ◽  
Oncologic Patients ◽  
Surgical Icu

145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p<0.001), with metastatic disease(81.7 vs 36.3, p<0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p<0.001) greater mean SAPS III (68.5±16.0 vs p<0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p<0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p<0.001), 1-month (60.0% vs 14.0%, p<0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.

Pediatric care

2015 ◽  
pp. 873-893
Author(s):  
Barbara Jones ◽  
Marcia Levetown ◽  
Melody Brown Hellsten
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Palliative Care ◽  
Intensive Care ◽  
Pediatric Care ◽  
Goals Of Care

Palliative care is as applicable in the emergency department (ED) and in the intensive care unit (ICU) setting as it is in the home. This chapter discusses transitioning goals of care between pediatric care settings, which is a critically important issue for children who die, since the vast majority of childhood deaths occur in an ICU setting.

scholarly journals The effectiveness of a tele-intensive care unit implementation at a secondary hospital in Eastern Saudi Arabia

2017 ◽  
Vol 4 (11) ◽  
pp. 3956
Author(s):  
Muhannad Aloraini
Keyword(s):  
Saudi Arabia ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Access To Health Care ◽  
Intervention Program ◽  
Care Quality ◽  
Post Intervention ◽  
Hospital Policy ◽  
Secondary Hospital

Background: Tele-intensive care units (tele-ICUs) are promising medical solutions for improving critical care quality, enhancing access to health care, and increasing the productivity of intensivists. King Faisal Specialist Hospital and Research Center (KFSHRC) initiated a tele-ICU implementation in Saudi Arabia during 2009/2010, with the aim of creating 28 tele-ICU-connected hospitals throughout the region by 2014. However, the effect of tele-ICUs on patient outcomes remains unclear. This study assessed the effectiveness of a tele-ICU intervention program on patient outcomes. Methods: A retrospective pre-post study was performed in an adult medical-surgical ICU at a secondary hospital in Eastern Saudi Arabia. Tele-intensivists were located at the KFSHRC. The sample comprised adult patients (≥12 years, as per hospital policy) admitted to the ICU. Patients were allocated into pre-intervention (January 1 to April 29, 2012) and post-intervention (May 1 to August 31, 2012) groups; each group had 178 patients. The tele-ICU was implemented on April 30, 2012. Results: According to a Mann–Whitney U-test, the groups did not differ on length of stay (LOS) (U=16097.50, p=0.78). Medians and interquartile ranges in length of stay for both groups were 2 days. Regarding mortality, 10 (5.6%) pre-intervention patients died, while 12 (6.7%) post-intervention patients died. This difference was not significant (p=0.51). Conclusions: The tele-ICU program did not appear to impact patient outcomes in terms of mortality or LOS. 

scholarly journals Family Perceptions of Palliative Care and Communication in the Surgical Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 237437352110330
Author(s):  
Kristina Paré ◽  
Joanna Grudziak ◽  
Kyle Lavin ◽  
May-Britt Sten ◽  
Anneka Huegerich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Acute Care Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Goals Of Care ◽  
Family Perceptions ◽  
Few Data ◽  
Care Surgery

Few data exist on palliative care for trauma and acute care surgery patients. This pilot study evaluated family perceptions and experiences around palliative care in a surgical intensive care unit (SICU) via mixed methods interviews conducted from February 1, 2020, to March 5, 2020, with 5 families of patients in the SICU. Families emphasized the importance of clear, honest communication, and inclusiveness in decision-making. Many interviewees were unable to recall whether goals-of-care discussions had occurred, and most lacked understanding of the patients’ illnesses. This study highlights the significance of frequent communication and goals-of-care discussions in the SICU.

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