Intensive Care Nurse-Driven Palliative Care Consult Screening Tool Implementation

Background: Intensive care unit (ICU) patients frequently encounter distressing symptoms that are commonly managed by palliative care (PC). Early PC involvement in the ICU has demonstrated decreased length of ICU stay, increased patient satisfaction rates, and reduced mortality and readmission rates.

Local problem: Despite observed benefits, PC remains severely underutilized in the ICU setting. Inpatient clinical providers do not consistently utilize evidence-based screening tools for early PC involvement in ICU patient care.

Methods: This quality improvement project used a mixed-method design. Descriptive data included responses from the Palliative Care Screening Criteria Survey for Key Stakeholders. Quantitative statistics included PC consult order completion rates pre- and post- project implementation and Likert-scale responses. Qualitative data included nursing staff perceptions of the screening tool implementation process.

Interventions: A site-specific PC consult screening tool was developed with an interdisciplinary key stakeholder team. The project was conducted over an eight-week period. Measurements included a key stakeholder survey, the PC consult screening tool, and nursing staff surveys. PC consult order rates were compared pre- and post- tool implementation. Nursing staff surveys were completed post- project to evaluate the tool’s acceptability, effectiveness, and adoption.

Results: No significant difference existed between pre- and post-project PC consult order rates (χ2 [1, N=515] = 0.77, p = 0.38). Staff nurse respondent perception of the screening tool was largely positive.

Conclusions: While no statistical significance occurred with PC consult screening tool implementation, staff nurse respondents felt it was relevant, user-friendly, and well-integrated.