Integration of Palliative Care Standards in the Icu at Kaiser Permanente Medical Center in Hawaiʻi

Abstract

Palliative care is medical care that enhances quality of life for patients living with serious advanced illness, by helping to align their treatment choices with their values. It has traditionally been used late in the care of patients, when all life-prolonging interventions have failed and death is imminent. Many chronically ill patients have not designated or discussed their care preferences with a surrogate decision maker. This omission can sometimes result in unwanted, aggressive treatments. There is evidence that demonstrates both the benefits of early identification of Goals-of-Care that are aligned with the patient’s wishes, and the importance of end-of-life care in the intensive care unit (ICU). A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Hawaii. The goal was to incorporate basic palliative care principles into the routine ICU care, and to increase the numbers of palliative care consultations as necessary, thereby enhancing the utilization of existing palliative care services and improving end-of-life care in the ICU. Pre- and post-interventional data showed an increase in the early identification of code status and Goals-of-Care, which, in turn, led to increased early ICU family meetings and also increased the numbers of palliative care consultations. Both the ICU length of stay and hospital length of stay decreased during the post-interventional period. The results from the family and nurse’s surveys were generally positive, and understanding of the process by the nursing staff showed improved trends throughout the interventional phase. It was concluded that integration of a structured palliative care program in the ICU was beneficial for patients, families and the ICU staff.