Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board.
OBJECTIVE
To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU.


METHODS
We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website.


METHODS
Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus.


METHODS
We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care.


RESULTS
The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU.


CONCLUSIONS
Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.
1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. 3Hartford Hospital, Hartford, CT. 4Center for Health Research, College of Nursing, Wayne State University, Detroit, MI. 5Section of Palliative Care, North Shore-Long Island Jewish Health System, Manhasset, NY. 6Department of Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, NJ. 7Department of Physiological Nursing, University of California, San Francisco, CA. 8Lehigh Valley Health Network, Allentown, PA. 9Boise, Meridian, & Mountain States Tumor Institute, St. Luke's Hospital, Boise, ID. 10Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD. 11Departments of Surgery and Health Policy, Medical College of Wisconsin, Milwaukee, WI. 12Cerebrovascular Center, Cleveland Clinic, Cleveland, OH. 13Departments of Rehabilitation Medicine, Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA. 14Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY.
Judith E
JE
Nelson
J Randall
JR
Curtis
Colleen
C
Mulkerin
Margaret
M
Campbell
Dana R
DR
Lustbader
Anne C
AC
Mosenthal
Kathleen
K
Puntillo
Daniel E
DE
Ray
Rick
R
Bassett
Renee D
RD
Boss
Karen J
KJ
Brasel
Jennifer A
JA
Frontera
Ross M
RM
Hays
David E
DE
Weissman
D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D010166:Palliative Care; D012017:Referral and Consultation