New palliative care screening device for surgical ICU sufferers could facilitate decision-making processes

To help in decision-making processes and enhance consciousness round palliative care within the Surgical Intensive Care Unit (SICU), a analysis staff on the College of North Carolina at Chapel Hill (UNC-Chapel Hill) has developed a screening device to determine—inside seconds—sufferers who could profit from palliative care consultations or objectives of care discussions. Their analysis findings, offered on the Scientific Discussion board throughout the American School of Surgeons (ACS) Scientific Congress 2022, present that the screening device efficiently recognized SICU sufferers who have been later deemed candidates for palliative care by their medical staff.

As a common and trauma surgeon, Trista Day Snyder Reid, MD, MPH, FACS, an assistant professor of surgical procedure at UNC Well being, and the examine’s medical advisor, defined that she typically witnesses medical groups and households make agonizing choices for sufferers within the SICU. When aggressive medical interventions won’t enhance outcomes or prolong life, palliative care remedy, which focuses on symptom administration and supportive communication, could enhance a affected person’s high quality of life. Sadly, a medical staff could hesitate to collectively determine acceptable sufferers or could refer sufferers to palliative care late of their SICU keep, growing the burden and stress on the affected person and their households.

“One of many issues that we discovered at our establishment was generally we might contain palliative care, however it might occur means down the road when the affected person had been within the SICU for a very long time already,” Dr. Reid stated. “We wish palliative care discussions to be occurring sooner. And even when we’re not involving palliative care, we would like objectives of care discussions to occur early so the household has a rapport with the medical staff and understands that their member of the family is basically sick.”

Throughout hospital techniques, screening standards and entry to palliative care range. Analysis has proven that providing palliative care consultations early in an ICU keep can enhance high quality of life and even scale back the lengths of keep within the ICU. Nonetheless, integrating palliative care into hospital techniques stays difficult on account of a scarcity of sources and inadequate coaching, amongst different components.

Examine particulars

The UNC researchers initially developed a screening device with 12 “sure/no” questions with enter from SICU and palliative care physicians, nurses, and superior follow suppliers. Fourth-year medical college students at UNC-Chapel Hill accomplished the questionnaire after receiving suggestions from the SICU medical staff. Any query the place the staff answered “sure” was deemed a constructive indicator that the affected person would profit from a palliative care session with a specialist or a objectives of care dialogue with the surgical staff.

Three iterations of the screening device have been developed utilizing the Plan-Do-Examine-Act (PDSA) technique earlier than deciding on three questions that the researchers discovered greatest correlated with a constructive indicator:

1. Any staff member (nursing, doctor, pharmacist, and many others.) expresses concern the affected person may have palliative care.
2. ICU or surgical staff solutions ‘no’ to the query: “Would you be shocked if this affected person died?”
3. Comorbidities: irreversible, progressive, or untreatable, severely impairing perform.

If sure was answered to any of the three guidelines questions, the researchers believed the affected person would probably profit from a palliative care session or objectives of care dialogue.

Key findings

• Screening instruments from 282 sufferers within the SICU have been recorded.
• Of these 282 sufferers, the screening device efficiently recognized 22 sufferers, all of whom finally obtained referrals for palliative care.
• Every affected person might be screened in about three seconds; all sufferers within the SICU might be screened in about 30 seconds.
• The device didn’t enhance the burden on the palliative care staff at UNC Well being.

“The hope is that through the use of this screening device, choices historically made very late within the affected person’s SICU keep, might be made a lot earlier,” stated lead writer Victoria Herdman, MD. Dr. Herdman was a fourth-year UNC-Chapel Hill medical scholar on the time of the examine and is now finishing her residency in cardiothoracic surgical procedure on the College of Kentucky School of Drugs. “Physicians, doctor assistants, nurse practitioners and nurses know early on who wants palliative care however generally that is exhausting to leap into early within the keep. This screening device is a method to information everybody into it simpler.”

The analysis was carried out at a single website, however the staff hopes to guage the device inside different ICU populations at UNC Well being utilizing a High quality Enchancment course of, presumably utilizing an digital medical document system or implementing it throughout every day rounds discussions with just one query. The examine staff additionally plans future analysis to research affected person demographics to find out which marginalized populations are sometimes ignored of palliative care discussions. Merely discussing palliative care extra typically and educating staff members and households, they stated, could make a distinction.

“I feel as surgeons we are inclined to have loads of possession of our sufferers as a result of they’re trusting us with their our bodies. However I feel which will additionally bias us slightly bit when it comes to palliative care. We hear the phrases ‘palliative care’ and will say, ‘Oh, no, no, no! We do not need that. That is like giving up on our affected person,'” Dr. Reid stated. “However the fact is, I feel loads of surgeons do not really perceive the definition of palliative care—that the aim is to align what the affected person desires together with your therapies. Our long-term hope is to make discussions of palliative care extra commonplace and to alter the tradition so that individuals really feel comfy involving palliative care, or at a minimal having a objectives of care dialogue, in order that sufferers and their households perceive all of the potential remedy choices.”

Extra data:
Herdman V, et al. Surgical Intensive Care Unit (SICU) Palliative Care Screening-Instrument: A High quality Enchancment (QI) Challenge, Scientific Discussion board, American School of Surgeons Scientific Congress 2022.