Increasing Equitable Access to Care: Implementation of Universal Palliative Care Screening in the Intensive Care Unit

Abstract

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations. PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?" Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance Palliative Care, systematic reviews, and retrospective cohort studies evaluating the use of palliative care screening tools in the acute care setting. Intervention: In a 6-bed ICU, a validated palliative care screening tool was implemented over an 8-week period to screen all ICU patients within 24 hours of admission. Pre and post-implementation data were collected from the electronic medical record to analyze the number of ICU patients screened, patients with positive screenings, and palliative care consultations placed. Outcome: Overall screening compliance was 71 percent for all ICU patients, with 66 percent screened within 24 hours of admission. Although there was not a significant increase in palliative care consultations, the time from ICU admission to consultation decreased by 2.88 days and the ICU mortality rate for patients with consultations decreased by 83 percent. Conclusion: The palliative care screening tool did not generate more palliative care consultations; however, this tool facilitated identification and consultation for patients earlier in the ICU stay. More work is needed to overcome barriers to consultation and expand access to palliative care services throughout all inpatient units.