Integrating Palliative Care Into a Neurosurgical Intensive Care Unit (NS-ICU): A Quality Improvement (QI) Project.

Autor:	Poi CH; Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore.; Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore., Koh MYH; Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore.; Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore., Koh TL; Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore.; Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore., Wong YL; Anaesthesiology, Intensive Care and Pain Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore., Mei Ong WY; Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore., Gu C; Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore., Yow FC; Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore., Tan HL; Anaesthesiology, Intensive Care and Pain Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	The American journal of hospice & palliative care [Am J Hosp Palliat Care] 2022 Jun; Vol. 39 (6), pp. 667-677. Date of Electronic Publication: 2021 Sep 15.
DOI:	10.1177/10499091211045616
Abstrakt:	Objectives: We conducted a pilot quality improvement (QI) project with the aim of improving accessibility of palliative care to critically ill neurosurgical patients. Methods: The QI project was conducted in the neurosurgical intensive care unit (NS-ICU). Prior to the QI project, referral rates to palliative care were low. The ICU-Palliative Care collaborative comprising of the palliative and intensive care team led the QI project from 2013 to 2015. The interventions included engaging key stake-holders, establishing formal screening and referral criteria, standardizing workflows and having combined meetings with interdisciplinary teams in ICU to discuss patients' care plans. The Palliative care team would review patients for symptom optimization, attend joint family conferences with the ICU team and support patients and families post-ICU care. We also collected data in the post-QI period from 2016 to 2018 to review the sustainability of the interventions. Results: Interventions from our QI project and the ICU-Palliative Care collaborative resulted in a significant increase in the number of referrals from 9 in 2012 to 44 in 2014 and 47 the year later. The collaboration was beneficial in facilitating transfers out of ICU with more deaths outside ICU on comfort-directed care (96%) than patients not referred (75.7%, p < 0.05). Significantly more patients had a Do-Not-Resuscitation (DNR) order upon transfer out of ICU (89.7%) compared to patients not referred (74.2.%, p < 0.001), and had fewer investigations in the last 48 hours of life (p < 0.001). Per-day ICU cost was decreased for referred patients (p < 0.05). Conclusions: Multi-faceted QI interventions increased referral rates to palliative care. Referred patients had fewer investigations at the end-of-life and per-day ICU costs.
Databáze:	MEDLINE
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