title: Integration of palliative care in the context of rapid response: a report from the Improving Palliative Care in the ICU advisory board.
abstract: Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Judith E
authors: JE
authors: Nelson
authors: Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: kusum.mathews@mssm.edu.
authors: Kusum S
authors: KS
authors: Mathews
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: David E
authors: DE
authors: Weissman
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: Karen J
authors: KJ
authors: Brasel
authors: Wayne State University, Detroit, MI.
authors: Margaret
authors: M
authors: Campbell
authors: University of Washington School of Medicine, Seattle, WA.
authors: J Randall
authors: JR
authors: Curtis
authors: The Cleveland Clinic, Cleveland, OH.
authors: Jennifer A
authors: JA
authors: Frontera
authors: VA Palo Alto Health Care System, Menlo Park, CA.
authors: Michelle
authors: M
authors: Gabriel
authors: University of Washington School of Medicine, Seattle, WA.
authors: Ross M
authors: RM
authors: Hays
authors: University of Washington School of Medicine, Seattle, WA.
authors: Anne C
authors: AC
authors: Mosenthal
authors: Rutgers New Jersey Medical School, East Orange, NJ.
authors: Colleen
authors: C
authors: Mulkerin
authors: Hartford Hospital, Hartford, CT.
authors: Kathleen A
authors: KA
authors: Puntillo
authors: University of California, San Francisco, San Francisco, CA.
authors: Daniel E
authors: DE
authors: Ray
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Stefanie P
authors: SP
authors: Weiss
authors: Lehigh Valley Health Network, Allentown, PA; Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Rick
authors: R
authors: Bassett
authors: Icahn School of Medicine at Mount Sinai, New York, NY; St. Luke's Hospital, Boise, ID.
authors: Renee D
authors: RD
authors: Boss
authors: Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY.
authors: Dana R
authors: DR
authors: Lustbader
mesh_terms: D016223:Advance Directives; D002983:Clinical Competence; D003142:Communication; D064648:Critical Care Nursing; D003657:Decision Making; D057209:Hospital Rapid Response Team; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D010817:Physician-Patient Relations
references: Crit Care Med. 2012 Jan;40(1):98-103
references: 21926596
references: Crit Care Resusc. 2013 Mar;15(1):15-20
references: 23432496
references: Mayo Clin Proc. 2010 Oct;85(10):949-54
references: 20805544
references: J Crit Care. 2005 Mar;20(1):90-6
references: 16015522
references: J Clin Oncol. 2007 Dec 20;25(36):5748-52
references: 18089870
references: Intensive Care Med. 2013 Nov;39(11):1916-24
references: 23925544
references: Chest. 2008 Oct;134(4):835-843
references: 18842916
references: Ann Emerg Med. 1997 Sep;30(3):365-72
references: 9287912
references: Chest. 2012 Oct;142(4):851-858
references: 22499827
references: Dimens Crit Care Nurs. 2011 Nov-Dec;30(6):321-5
references: 21983506
references: Arch Intern Med. 2012 Sep 10;172(16):1220-6
references: 22825806
references: Crit Care Med. 2010 Nov;38(11):2155-60
references: 20711069
references: Am J Respir Crit Care Med. 2007 Apr 1;175(7):686-92
references: 17234905
references: Crit Care Med. 2003 Sep;31(9):2255-62
references: 14501954
references: J Pain Palliat Care Pharmacother. 2008;22(4):306-11
references: 21923316
references: Crit Care Med. 1999 Mar;27(3):633-8
references: 10199547
references: J Palliat Med. 2013 Aug;16(8):894-900
references: 23786425
references: J Clin Ethics. 2013 Summer;24(2):98-112
references: 23923809
references: Jt Comm J Qual Patient Saf. 2008 Aug;34(8):489-95, 433
references: 18714752
references: Crit Care Med. 2013 Jan;41(1):263-306
references: 23269131
references: J Clin Med Res. 2013 Oct;5(5):343-9
references: 23976906
references: Crit Care Med. 2010 Sep;38(9):1765-72
references: 20562699
references: Intensive Care Med. 2003 May;29(5):774-81
references: 12677368
references: Crit Care Med. 2010 Mar;38(3):808-18
references: 20198726
references: Ann Intensive Care. 2012 Jul 27;2(1):34
references: 22839744
references: Crit Care Med. 2004 Jul;32(7):1484-8
references: 15241092
references: J Hosp Med. 2014 Jun;9(6):372-8
references: 24604884
references: JAMA. 2008 Dec 3;300(21):2506-13
references: 19050194
references: J Hosp Med. 2009 Sep;4(7):449-52
references: 19753581
references: Intensive Care Med. 2013 Nov;39(11):1925-31
references: 23921978
references: Crit Care Med. 2006 Jun;34(6):1679-85
references: 16625131
references: Intensive Care Med. 2014 Feb;40(2):235-248
references: 24275901
references: JAMA. 2011 Dec 28;306(24):2694-703
references: 22203538
references: Curr Opin Crit Care. 2007 Oct;13(5):482-8
references: 17762223
references: Ann Intern Med. 2011 Nov 1;155(9):593-601
references: 22041948
references: Acta Anaesthesiol Scand. 2013 Nov;57(10):1268-74
references: 24134444
references: CA Cancer J Clin. 2005 May-Jun;55(3):164-77
references: 15890639
references: J Gen Intern Med. 2008 Sep;23(9):1311-7
references: 18574641
references: J Crit Care. 2013 Aug;28(4):498-503
references: 23337483
references: Crit Care Resusc. 2007 Jun;9(2):151-6
references: 17536983
references: Resuscitation. 2008 Dec;79(3):391-7
references: 18952354
references: Curr Opin Crit Care. 2009 Dec;15(6):569-77
references: 19855271
references: J Bioeth Inq. 2013 Oct;10(3):297-308
references: 24048753
references: BMJ. 2010 Mar 23;340:c1345
references: 20332506
references: Resuscitation. 2013 Aug;84(8):1035-9
references: 23376582
references: Crit Care Med. 2014 Feb;42(2):322-7
references: 23989179
references: Crit Care Med. 2014 Jan;42(1):26-30
references: 23989173
references: Intensive Care Med. 2014 Apr;40(4):606-8
references: 24441669
references: Anaesthesiol Intensive Ther. 2014 Jan-Mar;46(1):46-9
references: 24643928
references: Crit Care Med. 2013 Oct;41(10):2284-91
references: 23921274
references: Nurs Ethics. 2002 Nov;9(6):636-50
references: 12450000
references: N Engl J Med. 2013 Mar 28;368(13):1173-5
references: 23465068
references: J Crit Care. 2003 Mar;18(1):22-4
references: 12640609
references: Crit Care Med. 2007 Mar;35(3):932-9
references: 17255876
references: Resuscitation. 2013 Apr;84(4):477-82
references: 22986066
references: Crit Care. 2013 Jan 23;17(1):107
references: 23343441
references: Crit Care Med. 2007 Feb;35(2):605-22
references: 17205007
references: Intensive Care Med. 2007 Jan;33(1):104-10
references: 17066284