Implementing primary palliative care best practices in critical care with the Care and Communication Bundle

Cristina Vuong, Sheri Kittelson, Lindsay McCullough, Yao Yingwei, Tonja Hartjes, Cristina Vuong, Sheri Kittelson, Lindsay McCullough, Yao Yingwei, Tonja Hartjes

Abstract

Background: Clinician-family communication is a central component of medical decision-making in the intensive care unit (ICU) and the quality of this communication has a direct impact on decisions made regarding care for patients who are critically ill.

Aim: The purpose of the project was to emphasise the need for quality improvement in the medical ICU at the University of Florida Health Hospital in regard to communication between the patients, families and providers.

Method: Interventions included development of a more systemic approach to primary palliative care by using the nationally recognised and published Care and Communication Bundle tool. The Bundle is a standardised clinical pathway of palliative care best practices.

Results: During the project period, staff satisfaction/engagement increased from tier 3 to tier 1 level, the medical ICU length of stay decreased from 4.97 days in fiscal year (FY) 2016 to 4.22 days in FY2017. Moreover, the number of patients discharged directly to hospice increased from 21 in FY2016 to 42 in FY2017, representing a 100% increase. Additionally, palliative care consults decreased in the medical ICU (FY2016=108, FY2017=82), as a result of an increase in daily primary palliative care interventions. The findings demonstrate an improvement in outcome measures during the project.

Keywords: Care and Communication Bundle; ICU; advance directive; critical care; family meeting; palliative care; provider communication.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
University of Florida (UF) Health Hospital MICU—patient/employee satisfaction survey. Using the patient/employee satisfaction survey that was already being implemented in the MICU for all patients, results from the interval period from which no family leaflet was in place to the time after implementation showed increase in survey measures including overall quality, communication, explanation of procedures and education on visitation policy. MICU, medical intensive care unit; PCA, patient care assistant.
Figure 2
Figure 2
University of Florida (UF) Health Hospital MICU—palliative care consults. Comparison of MICU palliative care consults prior to implementation of the Care and Communication Bundle (CCB) as seen in FY16 with palliative care consults in FY17 in which the CCB was in place. Palliative care consults rate decreased from 6.7% in FY16 to 4.5% in FY17. FY, fiscal year; MICU, medical intensive care unit.
Figure 3
Figure 3
University of Florida (UF) Health Hospital MICU—direct discharge to hospice. Prior to implementation of the Care and Communication Bundle (CCB), direct discharges from the MICU to hospice for FY16 were 1.3%. This increased to 2.3% in FY17 in which the bundle was implemented. FY, fiscal year; MICU, medical intensive care unit.
Figure 4
Figure 4
University of Florida (UF) Health Hospital MICU—employee engagement and satisfaction. Employee engagement and satisfaction scores are based on three domains: organisation, manager and employee satisfaction. In the year in which the bundle was in place (FY17), scores in all three domains increased in comparison to the year prior to the bundle implementation (FY16) showing an overall improvement in employee engagement and satisfaction. FY, fiscal year; MICU, medical intensive care unit.

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Source: PubMed

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