title: Palliative Care Needs in the Neuro-ICU.
abstract: OBJECTIVE
  Patients admitted to the neurological or neurosurgical ICU are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs.
  
  
  METHODS
  Quality improvement project using a parallel-group prospective cohort design.
  
  
  METHODS
  Single neuro-ICU at a large, academic medical center.
  
  
  METHODS
  All patients admitted to the neuro-ICU from September 1, 2013, to November 30, 2013.
  
  
  METHODS
  We developed a palliative care needs screening tool consisting of four questions: 1) Does the patient have distressing physical or psychological symptoms? 2) Are there specific support needs for patient or family? 3) Are treatment options matched with patient-centered goals? 4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for one of two neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening.
  
  
  RESULTS
  Over the 3-month period, 130 patients were admitted to the service with screening and 132 patients to the service without screening. The two groups did not differ with regard to age, gender, Glasgow Coma Scale, or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p = 0.019) and a trend toward more palliative care consultations (p = 0.056).
  
  
  CONCLUSIONS
  We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.
authors: 1Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA. 2Department of Pulmonary and Critical Care, University of Washington, Seattle, WA. 3Department of Neurocritical Care, University of Washington, Seattle, WA. 4Department of Neurology, University of Rochester, Rochester, NY.
authors: Claire J
authors: CJ
authors: Creutzfeldt
authors: Ruth A
authors: RA
authors: Engelberg
authors: Larry
authors: L
authors: Healey
authors: Chong Sherry
authors: CS
authors: Cheever
authors: Kyra J
authors: KJ
authors: Becker
authors: Robert G
authors: RG
authors: Holloway
authors: J Randall
authors: JR
authors: Curtis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015600:Glasgow Coma Scale; D006040:Goals; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009422:Nervous System Diseases / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration*; D011446:Prospective Studies; D012944:Social Support; D013727:Terminal Care / Q000458:organization & administration