C.H.POI1, M.YH.KOH1, T.L.Y.KOH1, Y.L.WONG1, W.Y.M.ONG1, CG.GU1, F.C.R.YOW1, H.L.TAN1
Tan Tock Seng Hospital1
We set up ICU-Palliative Care collaborative with the aim of improving accessibility of palliative care to critically ill neurosurgical patients. We aimed to assess the outcome between patients referred to palliative care versus those who did not.
The ICU-Palliative Care collaborative comprising of the palliative and intensive care team was set up in 2013. Multi-faceted interventions included engaging key stake-holders, establishing formal screening and referral criteria, standardising workflows and having combined meetings with interdisciplinary teams in ICU to discuss patients’ care plans were initiated from 2013 to 2015. The Palliative care team would review patients for symptom optimisation, attend joint family conferences with the ICU team and support patients and families post-ICU care. We also collected data from 2016 to 2018 to review the sustainability of these interventions.
Multi-faceted interventions resulted in a significant increase in the number of referrals from 9(2012) to 44(2014) and 47(2015). The collaboration was beneficial in facilitating transfers out of ICU with more deaths outside ICU on comfort directed care(96%) than patients not referred(75.7%, p< 0.05). Significantly more patients had a Do-Not-Resuscitation(DNR) order upon transfer out of ICU(89.7%) compared to patients not referred(74.2.%,p=0.001), and had fewer investigations in the last 48 hours of life(p<0.001). Per-day ICU cost was decreased for referred patients(p<0.05). These results were sustained in the post-QI period from 2016 to 2018.
ICU-Palliative care collaborative increased referral rates to palliative care. Referred patients had fewer investigations at the end-of-life and per-day ICU costs.