Standardized Palliative Care Screening in the Oncologic Intensive Care Unit
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Date
2023-12
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Publisher
The Ohio State University
Abstract
Background/Significance: Patients admitted to the oncologic Intensive Care Unit (ICU) face
numerous challenges including complex comorbid conditions, symptom burden, financial strain,
lengthy hospitalization, values conflicts, risk for readmission, and potential mortality despite
aggressive interventions. Such difficulties can be exacerbated by underlying cancer diagnoses
and complications secondary to cancer treatment. Palliative care aims to address these concerns.
Although national rates of palliative care referrals have been increasing among hospitalized
patients overall, the rate among ICU patients with cancer diagnoses has been decreasing in recent
years.
Purpose: The goal of this project was to increase identification of patients in the oncologic ICU
who had the greatest potential palliative care needs, thereby increasing the percentage of this
population with orders for palliative care consult. A secondary goal of this project was to assess
the impact of a palliative care screening tool on the timing of palliative care consult orders.
Intervention: With input from the Advanced Practice Registered Nurses for a 28-bed oncologic
ICU, a standardized screening tool was created to identify key palliative care needs in this patient
population. Screening criteria were derived from the Center to Advance Palliative Care's toolkit
for improving palliative care in the intensive care unit. The screening tool was utilized in daily
rounds for every patient, assisting in identifying palliative care needs as they developed over the
course of a patient's admission. This initial implementation period occurred over four weeks.
Evaluation: The rate of palliative care consults for patients in the oncologic ICU increased from
9.47% to 18.7% when compared to the same one-month time period one year previously. The
average number of days from ICU admission to palliative care consult increased from 2.7 days
during the control period to 4.6 days during the implementation. This indicates that the screening
tool helped identify palliative care needs that arose later in the ICU admission when compared to
pre-intervention.
Discussion: Palliative care has the potential to help manage many complex issues for patients in
the oncologic ICU. By creating a standardized screening tool that was utilized during daily
rounds, rates of palliative care consult orders doubled and palliative care needs were identified as
they arose later in the ICU admission. Utilizing a collaborative process in developing the tool
was key to its successful adoption and implementation.
Description
Keywords
palliative care, intensive care unit, ICU, screening tool, screening criteria, oncology