Center to Advance Palliative Care

Sally Norton and team recently published a study on proactive PC consults in a medical ICU. Norton et al (2007), Proactive PC in the MICU: Effects on LOS for selected high-risk patients, Critical Care Medicine 35 (6), 1530-1535. It's a good study, using several criteria for triggering a consult (including length of stay, which was also an outcome). There are a number of other ICU intervention studies such as Campbell & Guzman (2003, 2004); Schneiderman et al (2000, 2003). That being said, in terms of behavior change, it would be in your interest to convert an intensivist or two to this idea, and have them make it come from within the team, rather than imposed from outside their team. You may not get as much credit for it as your idea that way, but it will be much more likely to succeed rather than fail miserably. If you already have a successful track record in your hospital of providing "reactive" rather than proactive ICU consults, then you should already have ready the stories of who/ what/ when/ where/ why/ and how those occurred and solid data on the outcomes of those (focusing on issues that are important to the intensivists, not costs and revenue for the hospital for instance, which would be important to other external stakeholders but not to those whose behavior you're trying to change). Let me know what you think.
Brian Cassel,
Senior Analyst,
Thomas Palliative Care Program,
VCU Massey Cancer Center,
A Palliative Care Leadership Center