title: Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care.
abstract: OBJECTIVE
  Although successful models for palliative care delivery and quality improvement in the intensive care unit have been described, their applicability in surgical intensive care unit settings has not been fully addressed. We undertook to define specific challenges, strategies, and solutions for integration of palliative care in the surgical intensive care unit.
  
  
  METHODS
  We searched the MEDLINE database from inception to May 2011 for all English language articles using the term "surgical palliative care" or the terms "surgical critical care," "surgical ICU," "surgeon," "trauma" or "transplant," and "palliative care" or "end-of- life care" and hand-searched our personal files for additional articles. Based on review of these articles and the experiences of our interdisciplinary expert Advisory Board, we prepared this report.
  
  
  METHODS
  We critically reviewed the existing literature on delivery of palliative care in the surgical intensive care unit setting focusing on challenges, strategies, models, and interventions to promote effective integration of palliative care for patients receiving surgical critical care and their families.
  
  
  CONCLUSIONS
  Characteristics of patients with surgical disease and practices, attitudes, and interactions of different disciplines on the surgical critical care team present distinctive issues for intensive care unit palliative care integration and improvement. Physicians, nurses, and other team members in surgery, critical care and palliative care (if available) should be engaged collaboratively to identify challenges and develop strategies. "Consultative," "integrative," and combined models can be used to improve intensive care unit palliative care, although optimal use of trigger criteria for palliative care consultation has not yet been demonstrated. Important components of an improvement effort include attention to efficient work systems and practical tools and to attitudinal factors and "culture" in the unit and institution. Approaches that emphasize delivery of palliative care together with surgical critical care hold promise to better integrate palliative care into the surgical intensive care unit.
authors.affiliation: New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, NJ, USA. mosentac@umdnj.edu
authors.forename: Anne C
authors.initials: AC
authors.lastname: Mosenthal
authors.forename: David E
authors.initials: DE
authors.lastname: Weissman
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Ross M
authors.initials: RM
authors.lastname: Hays
authors.forename: Dana R
authors.initials: DR
authors.lastname: Lustbader
authors.forename: Colleen
authors.initials: C
authors.lastname: Mulkerin
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Puntillo
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ray
authors.forename: Rick
authors.initials: R
authors.lastname: Bassett
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boss
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Margaret
authors.initials: M
authors.lastname: Campbell
authors.forename: Judith E
authors.initials: JE
authors.lastname: Nelson
mesh_terms: D026683:Advisory Committees; D003422:Critical Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards
references.citation: J Palliat Med. 2011 Jan;14(1):17-23
references.pmid: 21133809
references.citation: Crit Care Med. 2010 Sep;38(9):1765-72
references.pmid: 20562699
references.citation: Surg Clin North Am. 2011 Apr;91(2):317-24, viii
references.pmid: 21419254
references.citation: J Am Coll Surg. 2002 May;194(5):665-73
references.pmid: 12022609
references.citation: Surg Clin North Am. 2006 Dec;86(6):1351-7
references.pmid: 17116452
references.citation: Chest. 2005 Nov;128(5):3599-610
references.pmid: 16304319
references.citation: Chest. 2006 Apr;129(4):954-9
references.pmid: 16608944
references.citation: JAMA. 2009 Aug 19;302(7):741-9
references.pmid: 19690306
references.citation: J Hosp Palliat Nurs. 2011 Mar;13(2):89-94
references.pmid: 21874122
references.citation: JAMA. 2010 Oct 27;304(16):1787-94
references.pmid: 20978258
references.citation: Intensive Care Med. 2003 Sep;29(9):1584-8
references.pmid: 12898001
references.citation: Crit Care Med. 2003 Sep;31(9):2255-62
references.pmid: 14501954
references.citation: Am J Med. 2000 Oct 15;109(6):469-75
references.pmid: 11042236
references.citation: Crit Care Med. 2004 Jul;32(7):1527-34
references.pmid: 15241097
references.citation: Chest. 2004 Oct;126(4):1292-8
references.pmid: 15486395
references.citation: Crit Care. 2010;14(6):R218
references.pmid: 21114837
references.citation: Crit Care Med. 2010 Mar;38(3):808-18
references.pmid: 20198726
references.citation: Crit Care Med. 2010 Mar;38(3):843-8
references.pmid: 20048678
references.citation: Arch Intern Med. 2010 Feb 22;170(4):369-76
references.pmid: 20177041
references.citation: Crit Care. 2006;10(6):R154
references.pmid: 17083735
references.citation: Intensive Care Med. 1995 Apr;21(4):302-9
references.pmid: 7650252
references.citation: Chest. 2003 Jan;123(1):266-71
references.pmid: 12527629
references.citation: J Am Coll Surg. 2004 Jul;199(1):149-60
references.pmid: 15217643
references.citation: Lancet. 2009 Aug 8;374(9688):444-5
references.pmid: 19681190
references.citation: Am J Respir Crit Care Med. 2008 Apr 15;177(8):912-27
references.pmid: 18390964
references.citation: Am J Surg. 2010 Oct;200(4):542-7
references.pmid: 20538256
references.citation: Am J Surg. 2011 Apr;201(4):492-7
references.pmid: 20850709
references.citation: Ann Surg Oncol. 2007 Jun;14(6):1801-6
references.pmid: 17342567
references.citation: Crit Care Med. 2003 May;31(5):1551-7; discussion 1557-9
references.pmid: 12771632
references.citation: N Engl J Med. 2010 Aug 19;363(8):733-42
references.pmid: 20818875
references.citation: J Trauma. 2008 Jun;64(6):1587-93
references.pmid: 18545128
references.citation: Crit Care Med. 2008 Mar;36(3):953-63
references.pmid: 18431285
references.citation: Ann Surg. 2011 Jan;253(1):151-7
references.pmid: 21135693
references.citation: JAMA. 2010 Mar 3;303(9):849-56
references.pmid: 20197531
references.citation: Am J Crit Care. 2002 Sep;11(5):459-66
references.pmid: 12233971
references.citation: Ann Surg. 2000 Feb;231(2):262-8
references.pmid: 10674619
references.citation: J Am Coll Surg. 2001 Sep;193(3):325-8
references.pmid: 11548803
references.citation: Crit Care Med. 2007 Jun;35(6):1530-5
references.pmid: 17452930
references.citation: Crit Care Med. 2009 Apr;37(4):1288-92
references.pmid: 19242344
references.citation: Crit Care Med. 2009 Oct;37(10):2775-81
references.pmid: 19581803
references.citation: J Trauma. 1990 Dec;30(12):1476-82
references.pmid: 2258958
references.citation: Crit Care Med. 2009 Mar;37(3):946-50
references.pmid: 19237901
references.citation: J Palliat Med. 2007 Apr;10(2):408-19
references.pmid: 17472513
references.citation: Surg Clin North Am. 2011 Apr;91(2):277-92, vii
references.pmid: 21419251
references.citation: Surgery. 2010 Jun;147(6):871-7
references.pmid: 20097397
references.citation: JAMA. 2011 Mar 9;305(10):1001-7
references.pmid: 21386078
references.citation: Crit Care Med. 2006 Nov;34(11 Suppl):S399-403
references.pmid: 17057605
references.citation: J Crit Care. 2007 Jun;22(2):159-68
references.pmid: 17548028