TY - JOUR
T1 - Choosing and using screening criteria for palliative care consultation in the ICU
T2 - A report from the improving palliative care in the ICU (IPAL-ICU) advisory board
AU - Nelson, Judith E.
AU - Curtis, J. Randall
AU - Mulkerin, Colleen
AU - Campbell, Margaret
AU - Lustbader, Dana R.
AU - Mosenthal, Anne C.
AU - Puntillo, Kathleen
AU - Ray, Daniel E.
AU - Bassett, Rick
AU - Boss, Renee D.
AU - Brasel, Karen J.
AU - Frontera, Jennifer A.
AU - Hays, Ross M.
AU - Weissman, David E.
PY - 2013/10
Y1 - 2013/10
N2 - Objective: To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU. Data Sources: We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus. Data Extraction: We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care. Data Synthesis: The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU. Conclusions: Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.
AB - Objective: To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU. Data Sources: We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus. Data Extraction: We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care. Data Synthesis: The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU. Conclusions: Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.
KW - critical care
KW - intensive care
KW - intensive care units
KW - palliative care
KW - referral and consultation
UR - http://www.scopus.com/inward/record.url?scp=84884910187&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e31828cf12c
DO - 10.1097/CCM.0b013e31828cf12c
M3 - Article
C2 - 23939349
AN - SCOPUS:84884910187
SN - 0090-3493
VL - 41
SP - 2318
EP - 2327
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 10
ER -