Applying the Care and Communication Bundle to Promote Palliative Care in a Neuro-Intensive Care Unit: Why and How

Area of Science:

• Neurocritical care
• Palliative care
• Quality improvement

Background:

• Palliative care delivery in neurointensive care units (neuro-ICUs) is often inconsistent due to a lack of formal care triggers.
• The Care and Communication Bundle (CCB) offers a standardized approach to palliative care in ICUs, but its application in neuro-ICUs requires evaluation.

Purpose of the Study:

• To assess the suitability of the CCB in a neuro-ICU setting using a novel scoring system.
• To identify barriers impacting adherence to CCB standards within the neuro-ICU.

Main Methods:

• Delineation of CCB standards specific to a neuro-ICU.
• Retrospective review of electronic medical records for 133 deceased neurocritical patients.
• Assessment of documented indicators and barriers to CCB adherence.

Main Results:

• Moderate adherence to CCB standards was observed.
• High consistency was noted in patient-centered communication and referrals to supportive services.
• Areas for improvement include documentation of patient/family involvement, advance directives, and interdisciplinary team meetings.

Conclusions:

• The CCB is a valuable tool for evaluating palliative care adherence in neuro-ICUs.
• A novel scoring system can motivate improvements and standardize palliative care integration.