Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit

Intensive care unit (ICU) care could be improved by implementation of time-triggered evidence-based interventions including identification of a patient/family medical decision maker, the patient's advance directive status, and cardiopulmonary resuscitation preferences by Day 1; offer of social work and spiritual support by Day 3; and a family meeting establishing goals of care by Day 5. We implemented a program to improve care for ICU patients in five Department of Veterans Affairs' ICUs.

We measured the percent of ICU patients with lengths of stay of five or more days that received the care processes by the appropriate day.

Critical care and palliative care providers trained ICU nurse teams to improve care through auditing, performance feedback, improvement tools, education, and monthly team meetings.

Pre- and postintervention care were compared. Offering social work and spiritual support, identification of the medical decision maker, and documentation of family meetings significantly improved.

ICU nurse teams can be engaged to improve care under the aegis of a collaborative quality improvement project.