Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Karen Hill

Committee Member

Dr. Chizimuzo Okoli

Abstract

PURPOSE: The purpose of this retrospective analysis was to determine the proportion of intensive care admissions that required palliative care services during the same admission assessed by an investigator-developed palliative care screening tool. This study also analyzed the screening tool for the number of criteria producing the highest sensitivity and specificity for a palliative care consult occurring during the same hospital stay.

METHODS: Retrospective data collection and analysis were performed by randomly selecting 110 patients records from a report obtained through the electronic health record, Epic. The sample was drawn from patients admitted to a medicine intensive care unit (2A) and neurology/neurosurgical intensive care unit (2B) at Baptist Health in Lexington Kentucky, a community-based tertiary care hospital, between April and August 2017.

RESULTS: Screening tool items capturing more than one trigger point produced the highest sensitivity and specificity under a ROC curve (.7/.422) resulting in a palliative care consultation during the same hospital stay. The utilization of palliative consultations when criteria on the tool was triggered was low at 20/79 (25.3%) patients. A palliative consult, when indicated, was carried out a median of 5.5 days after the initial admission to the intensive care unit. Missed opportunities for palliative consults were discovered with 8 out of the remaining 59 patients who warranted, but did not receive a consult, died since the reviewed ICU admission.

CONCLUSION: Palliative care consultations within the first twenty-four hours of an intensive care admission are needed but carried out at a low rate. The investigator-developed screening tool was effective in identifying the need for palliative care consultation. Palliative care screening tools need further validity testing as no standardize tool currently exists. Customizing tools for individual facility use is recommended and additional criteria should be considered.

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