Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit

Background: Intensive care unit (ICU) care could be improved by implementation of time-triggered evidence-based interventions including identification of a patient/family medical decision maker, the patient's advance directive status, and cardiopulmonary resuscitation preferences by Day 1; offer of social work and spiritual support by Day 3; and a family meeting establishing goals of care by Day 5. We implemented a program to improve care for ICU patients in five Department of Veterans Affairs' ICUs. Measures: We measured the percent of ICU patients with lengths of stay of five or more days that received the care processes by the appropriate day. Intervention: Critical care and palliative care providers trained ICU nurse teams to improve care through auditing, performance feedback, improvement tools, education, and monthly team meetings. Outcomes: Pre- and postintervention care were compared. Offering social work and spiritual support, identification of the medical decision maker, and documentation of family meetings significantly improved. Conclusions/Lessons Learned: ICU nurse teams can be engaged to improve care under the aegis of a collaborative quality improvement project.