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Palliative Care Needs in the Neuro-ICU

Creutzfeldt, Claire J. MD1; Engelberg, Ruth A. PhD2; Healey, Larry RN3; Cheever, Chong (Sherry) MSN, ANP-BC3; Becker, Kyra J. MD1; Holloway, Robert G. MD, MPH4; Curtis, J. Randall MD, MPH2

doi: 10.1097/CCM.0000000000001018
Neurologic Critical Care

Objectives: Patients admitted to the neurological or neurosurgical ICU are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs.

Design: Quality improvement project using a parallel-group prospective cohort design.

Setting: Single neuro-ICU at a large, academic medical center.

Patients: All patients admitted to the neuro-ICU from September 1, 2013, to November 30, 2013.

Interventions: We developed a palliative care needs screening tool consisting of four questions: 1) Does the patient have distressing physical or psychological symptoms? 2) Are there specific support needs for patient or family? 3) Are treatment options matched with patient-centered goals? 4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for one of two neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening.

Measurements and Main Results: Over the 3-month period, 130 patients were admitted to the service with screening and 132 patients to the service without screening. The two groups did not differ with regard to age, gender, Glasgow Coma Scale, or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p = 0.019) and a trend toward more palliative care consultations (p = 0.056).

Conclusions: We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.

1Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA.

2Department of Pulmonary and Critical Care, University of Washington, Seattle, WA.

3Department of Neurocritical Care, University of Washington, Seattle, WA.

4Department of Neurology, University of Rochester, Rochester, NY.

Dr. Creutzfeldt received support for article research from the National Institutes of Health (NIH), National Institute for Neurological Disorders and Stroke (NINDS) Stroke Trials Network Regional Coordinating Stroke Center (U10 NS08652501) (Principal Investigator: David Tirschwell), and the Cambia Health Foundation. Dr. Engelberg’s institution received grant support from Patient-Centered Outcome Research Institute and the Cambia Foundation. Dr. Becker consulted for Merck (outcomes adjudication committee) and provided expert testimony for various entities. Her institution received grant support from NINDS and AHA. Dr. Holloway consulted for Milliman Guidelines (reviewer of neurology guidelines) and Neurology Today (Associate Editor). His institution received grant support from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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