Screening tool identifies palliative care need early in ICU patients
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Key takeaways:
- More patients received palliative care referrals with a screening tool vs. traditional consultative methods.
- The screening tool automatically refers patients for palliative care consultation.
Use of a palliative care screening tool within 24 hours of ICU admission vs. traditional consultative methods helped identify more patients in need of this type of care, according to results published in Critical Care Nurse.
“Early recognition of patients who would benefit from palliative care discussions has a tremendous impact on improving the understanding of palliative care services and the distinction between hospice and palliative care for patients and family members,” Traci N. Phillips, DNP, APRN, ACNP-BC, CCRN, board-certified adult acute care nurse practitioner and member of the pulmonary and critical care service at Bon Secours Mercy Health-Anderson in Cincinnati, told Healio.
“The overall goal is to open the conversation and identify family decision-makers in the event the patient is unable to convey their wishes in the future,” Phillips continued. “The benefits can also expand into focusing on managing symptoms (breathlessness, pain, anxiety) while focusing on treating the patient in alignment with their goals of care.”
In this quality improvement project, Phillips and colleagues analyzed 267 ICU patients to determine if a palliative care screening tool completed within 24 hours of admittance could identify more patients in need of this type of care than the traditional consultative method.
The development of this tool was guided by the Institute for Healthcare Improvement model of plan-do-study-act cycles, according to researchers.
This screening tool was embedded in the EHR admission checklist, and nurses scored patients based on the presence of 12 comorbidities (dementia, end-stage renal failure, COPD/interstitial lung disease, etc) and nine contributing factors (past ICU admittance within 3 months, 30-day hospital readmission, ICU transfer due to deterioration, etc). Most clinical indicators were worth one point. An elevated total score (≥ 4 out of 23 points) signaled positive screening results and referral to palliative care.
“We designed our screening tool to automatically trigger requests for palliative care consultations for patients whose scores meet the defined criteria,” Phillips said in a press release.
Researchers found more patients who received referral with use of the palliative care screening tool vs. the traditional consultative method (n = 59; 22% vs. n = 31; 11.6%). Additionally, a positive screening result was observed among all patients with a referral from the traditional method.
When using the traditional method, an average of 6 days passed between hospital admittance and receipt of a consultation referral.
Of the total cohort, most were discharged to self-care (n = 124; 46%), followed by skilled nursing facilities (n = 35; 13%), home care (n = 31; 12%), long-term acute care hospitals (n = 16; 6%), hospice (n = 14; 5%) and other facilities (n = 9; 3%). The remaining 38 (14%) patients died while hospitalized.
Among the 35 individuals discharged to a skilled nursing facility, less than half of the patients with positive screening results received referral for consultation using the traditional method (six of 17 patients). The average number of days between admission and referral was 8.5 days.
Researchers noted poor outcomes among those with positive screening scores who did not receive palliative care referral, such as 6-month mortality (n = 4; 24%) and 30-day readmission (n = 5; 29%), whereas all but one of those granted a referral “received a revised code status that included identification of health care decision makers.”
For those discharged to skilled nursing facilities with positive screening scores, researchers observed three frequent clinical indicators: 30-day hospital readmission (n = 11; 65%), chronic lung disease (n = 10; 59%) and debility/failure to thrive (n = 7; 41%).
“Our experience tells us that patients with the highest risk of having unmet palliative care needs are those who have multiple comorbidities, repeated hospitalizations and who have shown decline in their functional status,” Phillips told Healio.
“Patients who have been recently hospitalized and require continued care that cannot be provided at home benefit from formal advanced care planning,” Phillips added. “These ACP discussions are best when the patient is capable of participating in the process regarding treatment goals including preferences for care in the future.”
When asked about future studies, Phillips said the team plans to keep advancing the screening criteria using patient and community feedback.
“Palliative care is gaining more recognition in the inpatient and the ambulatory settings as our patient needs become increasingly complex in an ever-changing health care landscape,” Phillips said. “Our team is very interested in continuing to track our data on referrals and follow outcomes to continue to adapt our screening criteria based on the potential needs of our patients and the medical community in which we serve.”
Reference:
- Screening tool streamlines requests for palliative care consultations. https://www.newswise.com/articles/view/808864/. Published March 26, 2024. Accessed April 1, 2024.