title: Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit.
abstract: BACKGROUND
  Intensive care unit (ICU) care could be improved by implementation of time-triggered evidence-based interventions including identification of a patient/family medical decision maker, the patient's advance directive status, and cardiopulmonary resuscitation preferences by Day 1; offer of social work and spiritual support by Day 3; and a family meeting establishing goals of care by Day 5. We implemented a program to improve care for ICU patients in five Department of Veterans Affairs' ICUs.
  
  
  METHODS
  We measured the percent of ICU patients with lengths of stay of five or more days that received the care processes by the appropriate day.
  
  
  METHODS
  Critical care and palliative care providers trained ICU nurse teams to improve care through auditing, performance feedback, improvement tools, education, and monthly team meetings.
  
  
  RESULTS
  Pre- and postintervention care were compared. Offering social work and spiritual support, identification of the medical decision maker, and documentation of family meetings significantly improved.
  
  
  CONCLUSIONS
  ICU nurse teams can be engaged to improve care under the aegis of a collaborative quality improvement project.
authors: James J. Peters VA Medical Center, Bronx, New York, USA. joan.penrod@mssm.edu
authors: Joan D
authors: JD
authors: Penrod
authors: Carol A
authors: CA
authors: Luhrs
authors: Elayne E
authors: EE
authors: Livote
authors: Therese B
authors: TB
authors: Cortez
authors: Jennifer
authors: J
authors: Kwak
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D010865:Pilot Projects; D058996:Quality Improvement; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs