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Evaluating the Outcomes of an Organizational Initiative to Expand End-of-Life Resources in Intensive Care Units With Palliative Support Tools and Floating Hospice. Dimens Crit Care Nurs 2020 Jul/Aug;39(4):219-235

Date

05/30/2020

Pubmed ID

32467406

DOI

10.1097/DCC.0000000000000423

Scopus ID

2-s2.0-85085635746

Abstract

BACKGROUND: There is evidence that palliative care and floating (inpatient) hospice can improve end-of-life experiences for patients and their families in the intensive care unit (ICU). However, both palliative care and hospice remain underutilized in the ICU setting.

OBJECTIVES: This study examined palliative consultations and floating hospice referrals for ICU patients during a phased launch of floating hospice, 2 palliative order sets, and general education to support implementation of palliative care guidelines.

METHODS: This descriptive, retrospective study was conducted at a level I trauma and academic medical center. Electronic medical records of 400 ICU patients who died in the hospital were randomly selected. These electronic medical records were reviewed to determine if patients received a palliative consult and/or a floating hospice referral, as well as whether the new palliative support tools were used during the course of care. The numbers of floating hospice referrals and palliative consults were measured over time.

RESULTS: Although not significant, palliative consults increased over time (P = .055). After the initial introduction of floating hospice, 27% of the patients received referrals; however, referrals did not significantly increase over time (P = .807). Of the 68 patients who received a floating hospice referral (24%), only 38 were discharged to floating hospice. There was a trend toward earlier palliative care consults, although this was not statistically significant (P = .285).

CONCLUSION: This study provided the organization with vital information about their initiative to expand end-of-life resources. Utilization and timing of palliative consults and floating hospice referrals were lower and later than expected, highlighting the importance of developing purposeful strategies beyond education to address ICU cultural and structural barriers.

Author List

McAndrew NS, McCracken C, Szabo A, Narayanan B, Peltier W, Leske J

Authors

Natalie McAndrew PhD, RN, ACNS-BC, CCRN Assistant Professor in the College of Nursing department at University of Wisconsin - Milwaukee
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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