Abstract
Purpose: Implementation of a palliative care screening tool into the electronic medical record (EMR) for use on patient admission or transfer to the intensive care unit (ICU) to promote earlier palliative care utilization for critically ill adult patients.|Background: ICU patients are at an increased risk of morbidity and mortality. Early inpatient palliative care consultation results in reduced readmissions, a decrease in inpatient mortality rates, and a decrease in hospital length of stay. However, ICU patients who would benefit from specialty palliative care often are unrecognized until late in their critical illness.|Sample/Setting: Adult patients admitted to the medical ICU at a Midwestern Level III trauma hospital during a 6-week study period (N=155).|Methods: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool, a reliable and valid tool used in Emergency Rooms, was embedded into the EMR of the study facility for testing in ICU patients. The P-CaRES tool was completed by bedside nurses either on transfer or admission to the ICU. A positive screen resulted in a best practice advisory for the attending provider to order a formal palliative consult.|Results: 92 P-CaRES (59%) were completed correctly on admission or transfer while 63 (41%) of screens were either not completed or completed incorrectly. Of the positive screens (n=11), 73% had a palliative consult ordered. While there were only 11 positive screens, 46 (30%) patients received a palliative care consult. 18 (11.6%) of study patients died within 6 days of their ICU admission.|Conclusion: Study findings support the importance of early palliative care involvement in the ICU. When completed correctly, the P-CaRES is an appropriate screening tool that can be used in the ICU setting to identify critically ill patients that would benefit from palliative care consultation.