title: Integrating palliative medicine and critical care in a community hospital.
abstract: Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. An ambassador program and expanded visiting hours turned the waiting room into part of the therapeutic environment. New palliative order sets and practice guidelines were introduced. Interdisciplinary care planning was guided by a family communication record. Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.
authors.affiliation: Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ray
authors.forename: Cathy
authors.initials: C
authors.lastname: Fuhrman
authors.forename: Glenn
authors.initials: G
authors.lastname: Stern
authors.forename: Jack
authors.initials: J
authors.lastname: Geracci
authors.forename: Thomas
authors.initials: T
authors.lastname: Wasser
authors.forename: Darryl
authors.initials: D
authors.lastname: Arnold
authors.forename: Tamara
authors.initials: T
authors.lastname: Masiado
authors.forename: Lynn
authors.initials: L
authors.lastname: Deitrick
mesh_terms: D003142:Communication; D003422:Critical Care / Q000458:organization & administration*; D004496:Education, Continuing; D005190:Family; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D009741:Nursing Staff, Hospital; D010166:Palliative Care / Q000458:organization & administration*; D017064:Process Assessment, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D014789:Visitors to Patients