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Integrating palliative care in the surgical and trauma intensive care unit: A report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care*

Mosenthal, Anne C. MD, FACS; Weissman, David E. MD, FACP; Curtis, J. Randall MD, MPH; Hays, Ross M. MD; Lustbader, Dana R. MD, FCCM, FCCP; Mulkerin, Colleen MSW, LCSW; Puntillo, Kathleen A. RN, DNSc, FAAN; Ray, Daniel E. MD, MS, FCCP; Bassett, Rick MSN, RN, APRN, ACNS-BC, CRRN; Boss, Renee D. MD; Brasel, Karen J. MD, MPH, FACS; Campbell, Margaret RN, FAAN, PhD; Nelson, Judith E. MD, JD

doi: 10.1097/CCM.0b013e31823bc8e7
Clinical Investigations

Objective: Although successful models for palliative care delivery and quality improvement in the intensive care unit have been described, their applicability in surgical intensive care unit settings has not been fully addressed. We undertook to define specific challenges, strategies, and solutions for integration of palliative care in the surgical intensive care unit.

Data Sources: We searched the MEDLINE database from inception to May 2011 for all English language articles using the term “surgical palliative care” or the terms “surgical critical care,” “surgical ICU,” “surgeon,” “trauma” or “transplant,” and “palliative care” or “end-of- life care” and hand-searched our personal files for additional articles. Based on review of these articles and the experiences of our interdisciplinary expert Advisory Board, we prepared this report.

Data Extraction and Synthesis: We critically reviewed the existing literature on delivery of palliative care in the surgical intensive care unit setting focusing on challenges, strategies, models, and interventions to promote effective integration of palliative care for patients receiving surgical critical care and their families.

Conclusions: Characteristics of patients with surgical disease and practices, attitudes, and interactions of different disciplines on the surgical critical care team present distinctive issues for intensive care unit palliative care integration and improvement. Physicians, nurses, and other team members in surgery, critical care and palliative care (if available) should be engaged collaboratively to identify challenges and develop strategies. “Consultative,” “integrative,” and combined models can be used to improve intensive care unit palliative care, although optimal use of trigger criteria for palliative care consultation has not yet been demonstrated. Important components of an improvement effort include attention to efficient work systems and practical tools and to attitudinal factors and “culture” in the unit and institution. Approaches that emphasize delivery of palliative care together with surgical critical care hold promise to better integrate palliative care into the surgical intensive care unit. (Crit Care Med 2012; 40:–1206)

From the New Jersey Medical School–University of Medicine and Dentistry of New Jersey (ACM), Newark, NJ; Mount Sinai School of Medicine (DEW, JEN), New York, NY; University of Washington Medical School (JRC); Seattle Children’s Hospital (RMH), Seattle, WA; North Shore-Long Island Jewish Health System (DRL), New York, NY; Hartford Hospital (CM), Hartford, CT; the University of California (KAP), Oakland, CA; Lehigh Valley Health Network (DER), Allentown, PA; St. Luke’s Hospital (RB), Boise, ID; Johns Hopkins University School of Medicine (RDB), Baltimore, MD; the Medical College of Wisconsin (KJB), Milwaukee, WI; and Wayne State University (MC), Detroit, MI.

The IPAL-ICU Project is based at Mount Sinai School of Medicine with support from the National Institute on Aging (K07 Academic Career Leadership Award AG034234 to Dr. Nelson) and the Center to Advance Palliative Care. Dr. Mosenthal received grant support from the NIH and Centers for Advanced Palliative Care. The remaining authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins