The Surgical Intensive Care Unit (SICU) presents a challenging environment for both medical professionals and families facing difficult decisions. A novel palliative care screening tool, developed at the University of North Carolina at Chapel Hill (UNC-Chapel Hill), aims to rapidly identify SICU patients who could benefit from palliative care consultations or goals of care discussions. This simple, three-question tool enables quicker identification, potentially leading to improved patient care and family support.
Streamlining Palliative Care Consultations in the ICU
Palliative care focuses on symptom management and improving quality of life, especially when aggressive medical interventions are unlikely to extend life or improve outcomes. Often, referrals to palliative care are delayed, adding to the stress and burden on patients and families. Recognizing this issue, researchers at UNC-Chapel Hill developed a streamlined screening tool to facilitate timely palliative care intervention in the SICU.
Dr. Trista Day Snyder Reid, MD, MPH, FACS, a general and trauma surgeon and assistant professor of surgery at UNC Health, highlighted the need for earlier intervention. “We want palliative care discussions, or at least goals of care discussions, to happen early so the family understands the severity of their loved one’s illness and builds rapport with the medical team,” she explained. This proactive approach can alleviate anxiety and facilitate open communication during a critical time.
Development and Implementation of the Screening Tool
The initial screening tool consisted of 12 yes/no questions, developed with input from SICU and palliative care professionals. Through iterative refinement using the Plan-Do-Study-Act (PDSA) method, the tool was condensed to three key questions:
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Team Member Concern: Does any team member (nurse, physician, pharmacist, etc.) express concern that the patient may need palliative care?
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Mortality Expectation: Does the ICU or surgical team answer “no” to the question: “Would you be surprised if this patient died?”
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Comorbidity Burden: Does the patient have irreversible, progressive, or untreatable comorbidities that severely impair function?
A “yes” answer to any of these questions indicates a potential need for palliative care consultation or a goals of care discussion. This efficient process allows for rapid screening of all SICU patients, taking approximately 30 seconds for the entire unit.
Positive Results and Future Directions
In a study of 282 SICU patients, the screening tool successfully identified 22 individuals who ultimately received palliative care referrals. Notably, the tool did not increase the workload on the palliative care team. Lead author Dr. Victoria Herdman, MD, emphasized the tool’s potential to facilitate earlier intervention. “Physicians and nurses often recognize the need for palliative care early on, but initiating those conversations can be difficult. This tool provides a framework for easier and more timely discussions,” she stated.
Future research will focus on expanding the tool’s implementation across other ICU populations within UNC Health and exploring its potential use in electronic medical record systems. The research team also plans to analyze patient demographics to ensure equitable access to palliative care consultations. Ultimately, this innovative screening tool has the potential to transform palliative care delivery in the ICU, ensuring that patients and their families receive timely support and guidance during challenging times. Changing the perception of palliative care among surgeons is crucial. Dr. Reid notes that many surgeons mistakenly equate palliative care with “giving up,” when in reality, it’s about aligning treatment with patient wishes.
