The challenges of establishing a palliative care collaboration with the intensive care unit: How we did it? A prospective observational study

Abstract

Background

Palliative care should be an integral component of comprehensive ICU care for all critically ill patients.

Objectives

We aimed to study and describe the impact of an ICU-Palliative Care Collaboration using a ICU screening criteria and its influence on referral rates and outcomes.

Methods

This was a prospective, observational study that included all critically ill patients who were referred to our ICU-Palliative Care Service over a 3-year period from January 2016 to December 2018 in a 1500-bed teaching hospital. Critically ill patients who met the referral criteria would be referred to our ICU-Palliative Care Service.

Results

A total of 662 critically ill patients were referred during the study period. 398(60.1%) patients had withdrawal of ventilator.595(89.9%) of 662 patients referred to palliative care died. 284(42.9%) patients died in the ICU. The palliative care team continued to care for the remaining 378 patients who were transferred out of the ICU to the general ward.

Conclusions

Our ICU-Palliative Care service provided care for critically ill patients with palliative care needs in a seamless and holistic manner in both the ICU and post-ICU settings. The establishment of a screening criteria allowed patients with potentially unmet palliative care needs to be identified and referred to palliative care. Active screening and collaborative efforts between the ICU and palliative care team resulted a significant increment in referral rates.

Keywords:

• ICU-Palliative care
• Collaboration
• Palliative care
• Critical care
• Intensive care
• Referral criteria

Acknowledgements

The authors would like to thank Dr Allyn Hum for her support and revising the manuscript for publication, Miss Li Li (Assistant Manager, ICU Operations, Tan Tock Seng Hospital), Miss Carin Low Zhi Jun (Research Assistant, Tan Tock Seng Hospital), Miss Jermain Chu Choy Ning (Research Assistant, Tan Tock Seng Hospital) and Miss Zhang Junjun (Palliative Care Co-Ordinator, Tan Tock Seng Hospital) for their expertise with data management and analysis.

Disclaimer statements

Contributors None.

Funding The ICU-Palliative care Service was part of a healthcare improvement project. This was a service collaboration within our hospital. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interests The authors report no conflicts of interest.

Ethics approval Ethical approval was obtained from the Institutional Review Board: National Healthcare Group (NHG) Domain Specific Review Board (DSRB) has approved the study. The NHG DSRB reference number for this study is 2020/00009.

Additional information

Notes on contributors

Choo Hwee Poi

Dr Choo Hwee Poi & Dr Mervyn Yong Hwang Koh are Senior Consultants in Department of Palliative Care.

Ms Wendy Yu Mei Ong is clinical nurse specialist.

Ms Fionna Chunru Yow is advanced nurse practitioner.

Hui Ling Tan

Dr Hui Ling Tan is senior consultant in Department of Anesthesiology, Intensive Care & Pain Medicine, ICU Committee Chair, Assistant Chairman of Medical Records (Clinical Quality & Audit).