title: Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases.
abstract: BACKGROUND
  Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team.
  
  
  OBJECTIVE
  Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations.
  
  
  METHODS
  A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria.
  
  
  METHODS
  These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting.
  
  
  RESULTS
  Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly.
  
  
  CONCLUSIONS
  Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.
authors.affiliation: 1 Department of Physician Services, The Rehabilitation Hospital of the Pacific, Honolulu, HI, USA.
authors.forename: Eluned
authors.initials: E
authors.lastname: Mun
authors.affiliation: 2 Department of Intensive Care Unit, Kaiser Permanente Medical Center, Honolulu, HI, USA.
authors.forename: Lillian
authors.initials: L
authors.lastname: Umbarger
authors.affiliation: 3 Department of School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA.
authors.forename: Clementina
authors.initials: C
authors.lastname: Ceria-Ulep
authors.affiliation: 4 Department of Palliative Care, Kaiser Permanente Medical Center, Honolulu, HI, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Nakatsuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D012017:Referral and Consultation / Q000458:organization & administration; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors; D057188:Workflow; D055815:Young Adult
keywords: ICU; advanced care planning; family meeting; palliative care; palliative care team; quality improvement