Addressing access to palliative care services in the surgical intensive care unit

Proactive case-finding using consultation triggers is a currently unexplored technique of increasing access to palliative care for patients in the surgical intensive care unit (SICU).

A retrospective, pre- and postintervention study examined the effect of an initiative involving palliative care consultation in a 21-bed SICU at an urban, tertiary referral center. The initiative identified patients meeting a set of consultation triggers suggested by a group of physicians with expertise in surgical palliative care. The charts of 300 patients were reviewed retrospectively before the initiative (Group I), and 344 charts were reviewed after the initiative (Group II) for the presence of a trigger and/or subsequent palliative care consultation.

Triggers were rare in both groups (Group I, 5.7%; Group II, 5.5%). Palliative care consultations were also infrequent, without change before and after the intervention (Group I, 2.3%; Group II, 3.1%). There was no difference in consultations for patients meeting a trigger after the initiative (17.6% to 27.3%; P = .704).

Implementation of triggers does not increase palliative care consultations in the SICU. As an isolated intervention, triggers occur in too few patients to improve overall access to palliative care, suggesting that other methods should be further explored.