title: Integrating palliative and critical care: description of an intervention.
abstract: A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.
authors.affiliation: Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Patsy D
authors.initials: PD
authors.lastname: Treece
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Shannon
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nielsen
authors.forename: Theresa
authors.initials: T
authors.lastname: Braungardt
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Steinberg
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D003422:Critical Care / Q000458:organization & administration*; D005190:Family; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008020:Life Support Care / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration; D014481:United States; D028761:Withholding Treatment