title: Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU.
abstract: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU?
  
  
  
  Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS.
  
  
  
  A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients' families and/or palliative care consultations.
  
  
  
  Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS.
  
  
  
  A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased.
  
  
  
  It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS.
authors.affiliation: Retired Intensive Care Nurse and a current Nurse Practitioner at the Rehabilitation Hospital of the Pacific in Honolulu, HI. emun@rehabhospital.org.
authors.forename: Eluned
authors.initials: E
authors.lastname: Mun
authors.affiliation: Professor and Department Chair in the School of Nursing and Dental Hygiene at the University of Hawaii at Manoa in Honolulu. clem@hawaii.edu.
authors.forename: Clementina
authors.initials: C
authors.lastname: Ceria-Ulep
authors.affiliation: Intensivist and Pulmonologist at the Moanalua Medical Center in Honolulu, HI. lillian.a.umbarger@kp.org.
authors.forename: Lillian
authors.initials: L
authors.lastname: Umbarger
authors.affiliation: Palliative Care and Internal Medicine Physician at the Moanalua Medical Center in Honolulu, HI. craig.nakatsuka@kp.org.
authors.forename: Craig
authors.initials: C
authors.lastname: Nakatsuka
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D059019:Clinical Coding; D003422:Critical Care; D005260:Female; D006040:Goals; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards; D000070659:Patient Comfort; D058996:Quality Improvement; D012017:Referral and Consultation; D013727:Terminal Care / Q000592:standards; D055815:Young Adult