Standardized Palliative Care Screening in the Oncologic Intensive Care Unit
The Ohio State University
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.
palliative care, intensive care unit, ICU, screening tool, screening criteria, oncology