Utilising Palliative Care Expertise in Critically Ill Patients: Opportunities to Improve Outcomes and Experiences

Background: Prior to the COVID-19 pandemic, the mortality of patients admitted to intensive care units (ICUs) in the UK reached 20%. Studies show up to 40% of these patients may have been eligible for palliative care (PC) referral on admission to the ICU. The involvement of PC teams improves the quality of care delivered and improves patient and family satisfaction. Several trigger tools have been developed to identify ICU patients most likely to benefit from palliative care; however, no consensus exists regarding the most effective tool. Methods: We conducted a retrospective study to identify the number of PC referrals, prior to death in a general ICU setting over a 7-month period in 2019. For patients not referred to PC, three separate "trigger tools", previously described in the literature, were retrospectively applied to explore the potential impact each tool may potentially have had on PC referral rates. Results: We identified 121 ICU deaths, of which 28 patients (23%) were referred to PC during their admission to the ICU. After retrospective application of the trigger tools to those who were not referred, 75% (n = 70) of patients triggered at least one criterion using the "Zalenski et al." tool and 71% (n = 66) of patients were eligible for referral had the "Hua et al." tool had been used. Overall, 82% (n = 36) of cancer patients met at least one criterion for referral with the Royal Marsden tool. Conclusions: Our study supports a finding of poor utilisation of PC services in an ICU patient population. The use of trigger tools can be used to significantly increase the number of appropriate PC referrals in an intensive care setting and may be useful in predicting those who may die. The benefit of PC intervention is aimed at providing holistic support to both patient and family and is associated with better patient and family experience towards the end of life.