title: Developing triggers for the surgical intensive care unit for palliative care integration.
abstract: Despite the growing acceptance of palliative care as a component of high-quality care for patients with serious illness, it remains underutilized in the surgical critical care setting. This article provides insight into a model for palliative care integration into the surgical intensive care unit (SICU), using triggers.
  
  
  
  We performed a prospective cohort study after the implementation of a new set of palliative care triggers in the SICU of an 1170-bed tertiary medical center over the course of 9 months. We aimed to determine the ability of these triggers to identify patients who would benefit from palliative care consultation.
  
  
  
  There were 517 SICU admissions during the period of interest. Of this cohort, patients who had not yet been discharged at the time of analysis were excluded (n=25), and the remaining underwent analysis (n=492). Factors significantly associated with hospital death or hospice discharge were repeat SICU admission, metastatic/advanced cancer, SICU physician referral, and the matching of 2 or more secondary criteria.
  
  
  
  A series of triggers can help identify patients who may benefit from palliative care consultation. This approach can be used in intensive care settings to facilitate palliative care integration.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Finkelstein
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Geriatrics Research Education and Clinical Care Center, James J Peters VA Medical Center, Bronx, NY.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Goldstein
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Horton
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Eshak
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: roopa.kohli-seth@mountsinai.org.
authors.forename: Roopa
authors.initials: R
authors.lastname: Kohli-Seth
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D019091:Critical Pathways; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009518:New York; D010166:Palliative Care; D010343:Patient Admission; D011446:Prospective Studies; D013514:Surgical Procedures, Operative
keywords: Critical care; Outcomes assessment; Palliative care; Patient care; Quality improvement