Improving social work in intensive care unit palliative care: results of a quality improvement intervention.
OBJECTIVE
The intensive care unit (ICU) is a focal point for decision making in end-of-life care. Social workers are involved in providing this care for patients and families. Our goal was to examine the social worker component of an intervention to improve interdisciplinary palliative care in the ICU.


METHODS
The study took place at a 350-bed hospital with 65 ICU beds. We surveyed family members and social workers caring for patients who died in the ICU or within 30 hours of transfer from ICU. Clustered regression was used to assess the effect of the intervention on three outcomes: (1) families' satisfaction with social work, (2) social workers' reported palliative and supportive activities, and (3) social workers' satisfaction with meeting family needs.


RESULTS
Of 590 eligible patients, 275 families completed surveys (response rate, 47%). Thirty-five social workers received 353 questionnaires concerning 353 unique patients and completed 283 (response rate, 80%). Social workers reported significant increase in the total number of activities for family members after the intervention. Some of the activities included addressing spiritual or religious needs, discussing disagreement among the family, and assuring family the patient would be kept comfortable. Neither social workers' satisfaction with meeting families' needs nor family ratings of social workers were higher after the intervention. Increased social worker experience and smaller social worker caseload were both associated with increased family satisfaction with social work.


CONCLUSIONS
The increase in social worker-reported activities supports the value of the interdisciplinary intervention, but we did not demonstrate improvements in other outcomes. Increased social-worker experience and decreased social worker caseload were independently associated with better family ratings of social workers suggesting future directions for interventions to improve care by social workers. Future studies will need more powerful interventions or more sensitive outcome measures to document improvements in family-assessed outcomes.
McCormick
Andrew J
AJ
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center University of Washington, Seattle, Washington 98104-2499, USA.
Curtis
J Randall
JR
Stowell-Weiss
Patti
P
Toms
Carol
C
Engelberg
Ruth
R
D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior; D005260:Female; D019538:Health Care Surveys; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D012947:Social Work / Q000592:standards*; D014193:Trauma Centers