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

Abstract

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 Care'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 patients' 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.

Conflict of interest statement

Statement The author(s) have no conflicts of interest to disclose.

Figures

Figure 1

Final workflow, which incorporated guidelines from Improving Palliative Care in the Intensive Care Unit recommendations. ICU = intensive care unit; MD = physician; RN = registered nurse.