Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU

摘要

Context: 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?Objective: 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.Design: A program was developed that followed recommendations from the Center to Advance Palliative Carea??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 patientsa?? families and/or palliative care consultations.Main Outcome Measures: Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS.Results: 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.Conclusion: It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS.