Integrating palliative and critical care: Evaluation of a quality-improvement intervention

J. Randall Curtis, Patsy D. Treece, Elizabeth L. Nielsen, Lois Downey, Sarah Shannon, Theresa Braungardt, Darrell Owens, Kenneth P. Steinberg, Ruth A. Engelberg

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Rationale: Palliative care in the intensive care unit (ICU) is an important focus for quality improvement. Objectives: To evaluate the effectiveness of a multi-faceted quality improvement intervention to improve palliative care in the ICU. Methods: We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. The intervention consisted of clinician education, local champions, academic detailing, feedback to clinicians, and system support. Consecutive patients who died in the ICU were identified pre- (n = 253) and postintervention (n = 337). Families completed Family Satisfaction in the Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) surveys. Nurses completed the QODD. The QODD and FS-ICU were scored from 0 to 100. We used Mann-Whitney tests to assess family results and hierarchical linear modeling for nurse results. Measurements and Main Results: There were 590 patients who died in the ICU or within 24 hours of transfer; 496 had an identified family member. The response rate for family members was 55% (275 of 496) and for nurses, 89% (523/590). The primary outcome, the family QODD, showedatrend towardimprovement (pre,62.3; post, 67.1), but was not statistically significant (P = 0.09). Family satisfaction increased but not significantly. The nurse QODD showed significant improvement (pre, 63.1; post, 67.1; P < 0.01) and there was a significant reduction in ICU days before death (pre, 7.2; post, 5.8; P < 0.01). Conclusions: We found no significant improvement in family-assessed qualityof dyingor in family satisfaction with care, we found but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. Improving family ratings may require interventions that have more direct contact with family members.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume178
Issue number3
DOIs
StatePublished - Aug 1 2008
Externally publishedYes

Fingerprint

Critical Care
Quality Improvement
Palliative Care
Intensive Care Units
Nurses
Length of Stay
Education

Keywords

  • Critical care
  • End-of-life care
  • Intensive care
  • Palliative care
  • Withdrawing life support

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Curtis, J. R., Treece, P. D., Nielsen, E. L., Downey, L., Shannon, S., Braungardt, T., ... Engelberg, R. A. (2008). Integrating palliative and critical care: Evaluation of a quality-improvement intervention. American Journal of Respiratory and Critical Care Medicine, 178(3), 269-275. https://doi.org/10.1164/rccm.200802-272OC

Integrating palliative and critical care : Evaluation of a quality-improvement intervention. / Curtis, J. Randall; Treece, Patsy D.; Nielsen, Elizabeth L.; Downey, Lois; Shannon, Sarah; Braungardt, Theresa; Owens, Darrell; Steinberg, Kenneth P.; Engelberg, Ruth A.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 178, No. 3, 01.08.2008, p. 269-275.

Research output: Contribution to journalArticle

Curtis, JR, Treece, PD, Nielsen, EL, Downey, L, Shannon, S, Braungardt, T, Owens, D, Steinberg, KP & Engelberg, RA 2008, 'Integrating palliative and critical care: Evaluation of a quality-improvement intervention', American Journal of Respiratory and Critical Care Medicine, vol. 178, no. 3, pp. 269-275. https://doi.org/10.1164/rccm.200802-272OC
Curtis, J. Randall ; Treece, Patsy D. ; Nielsen, Elizabeth L. ; Downey, Lois ; Shannon, Sarah ; Braungardt, Theresa ; Owens, Darrell ; Steinberg, Kenneth P. ; Engelberg, Ruth A. / Integrating palliative and critical care : Evaluation of a quality-improvement intervention. In: American Journal of Respiratory and Critical Care Medicine. 2008 ; Vol. 178, No. 3. pp. 269-275.
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abstract = "Rationale: Palliative care in the intensive care unit (ICU) is an important focus for quality improvement. Objectives: To evaluate the effectiveness of a multi-faceted quality improvement intervention to improve palliative care in the ICU. Methods: We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. The intervention consisted of clinician education, local champions, academic detailing, feedback to clinicians, and system support. Consecutive patients who died in the ICU were identified pre- (n = 253) and postintervention (n = 337). Families completed Family Satisfaction in the Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) surveys. Nurses completed the QODD. The QODD and FS-ICU were scored from 0 to 100. We used Mann-Whitney tests to assess family results and hierarchical linear modeling for nurse results. Measurements and Main Results: There were 590 patients who died in the ICU or within 24 hours of transfer; 496 had an identified family member. The response rate for family members was 55{\%} (275 of 496) and for nurses, 89{\%} (523/590). The primary outcome, the family QODD, showedatrend towardimprovement (pre,62.3; post, 67.1), but was not statistically significant (P = 0.09). Family satisfaction increased but not significantly. The nurse QODD showed significant improvement (pre, 63.1; post, 67.1; P < 0.01) and there was a significant reduction in ICU days before death (pre, 7.2; post, 5.8; P < 0.01). Conclusions: We found no significant improvement in family-assessed qualityof dyingor in family satisfaction with care, we found but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. Improving family ratings may require interventions that have more direct contact with family members.",
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