The Practical Implementation of an Embedded Palliative Care Team in a Medical Intensive Care Unit (QI435)

1. Increase knowledge and awareness about how to implement an embedded palliative care (PC) team in an intensive care unit environment 2. Describe appropriate trigger criteria for PC referral for patients admitted to the medical intensive care unit Many patients admitted to the medical intensive care unit (MICU) have unmet palliative care needs due to lack of staff knowledge and objective trigger criteria for referral. Embedding a palliative care (PC) team in the MICU will improve patient care by facilitating early PC involvement and intervention to reduce unwanted or unnecessary aggressive medical care for patients at the end of life. In mid-January 2019, a PC team consisting of 1 physician, 2 nurse practitioners, and 1 social worker was formally embedded in a 31-bed MICU. The team was modeled after guidelines of the ICU-IPAL Project. PC trigger criteria for referral were developed. Trigger criteria included advanced stage cancer, multiorgan failure, major acute neurologic insult, advanced stage disease (dementia, COPD, CHF, liver or renal disease), and severe COVID-19. Thenumber of PC consultations placed in the MICU increased by 283% (284 consults in 2018 and 803 consults in 2020), which is strongly related to excellent collaboration between nursing staff, the PC team, and MICU physicians. The average number of days from admission to PC consult has decreased from 3.84 (2018) to 1.72 (2020). The numbers of advance directives (healthcare proxy and Do Not Resuscitate) obtained increased between 2019 and 2020, as did the number of patients who transitioned to comfort measures. Anembedded PC team in the MICU has improved early PC intervention, increased staff awareness, and led to an increase in the use of PC services for critically ill patients. Consideration of an embedded PC team in the intensive care environment may lead to improved patient care and satisfaction with early advance care planning discussions and documentation. Additionally, providers and staff may have increased satisfaction from having consistent support when dealing with advance care planning discussions for patients with serious, life-limiting illnesses.