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

Anne C. Mosenthal, David E. Weissman, J. Randall Curtis, Ross M. Hays, Dana R. Lustbader, Colleen Mulkerin, Kathleen A. Puntillo, Daniel E. Ray, Rick Bassett, Renee D. Boss, Karen J. Brasel, Margaret Campbell, Judith E. Nelson

Research output: Contribution to journalReview article

84 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1199-1206
Number of pages8
JournalCritical care medicine
Volume40
Issue number4
DOIs
StatePublished - Apr 2012

Keywords

  • ICU palliative care
  • end-of-life care
  • surgeon attitude
  • surgical intensive care
  • surgical outcome
  • surgical palliative care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Mosenthal, A. C., Weissman, D. E., Curtis, J. R., Hays, R. M., Lustbader, D. R., Mulkerin, C., Puntillo, K. A., Ray, D. E., Bassett, R., Boss, R. D., Brasel, K. J., Campbell, M., & Nelson, J. E. (2012). 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. Critical care medicine, 40(4), 1199-1206. https://doi.org/10.1097/CCM.0b013e31823bc8e7