title: Merging cultures: palliative care specialists in the medical intensive care unit.
abstract: We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork. Additional problems were noted but not well addressed, particularly routine communication with families and continuity of care for complex patients leaving the ICU.
authors.affiliation: Palliative Care Service, Massachusetts General Hospital and the Harvard Medical School Center for Palliative Care, Boston, Massachusetts, USA.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Billings
authors.forename: Adele
authors.initials: A
authors.lastname: Keeley
authors.forename: Joel
authors.initials: J
authors.lastname: Bauman
authors.forename: Alex
authors.initials: A
authors.lastname: Cist
authors.forename: Edward
authors.initials: E
authors.lastname: Coakley
authors.forename: Connie
authors.initials: C
authors.lastname: Dahlin
authors.forename: Paul
authors.initials: P
authors.lastname: Montgomery
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wise
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D004496:Education, Continuing; D005190:Family; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000193:education; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*; D014789:Visitors to Patients