Views
CAPC Palliative Care Discussion Forum
Palliative Care and the ICU
MANDATED CONSULTSDate: Sep 14, 2007 11:22 pm
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| Re:MANDATED CONSULTS (by stone on 10/04/2007)
I think that our medical ICU's would be not receptive to the idea of mandated consults-that may come across as paternalistic and it would be best to let them think of calling. Now that being said it seems that maybe if nursing staff have triggers and "suggest" the consult it would be received.
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| Re:MANDATED CONSULTS (by lwmelhad on 10/05/2007)
We are part of the ICU interdisciplinary team; We round on every patient in our 32 bed ICU; The ICU intensivist welcomes input from the Palliative Care Team..consults are not mandated. We make polite suggestions. So far, the ICU intensivists are our biggest referrals. We also thank him and tell him know how much we appreaciate His support!
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| Re:MANDATED CONSULTS (by jbcassel on 10/12/2007)
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
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| Re:MANDATED CONSULTS (by sgray on 10/30/2007)
We too are part of the rounding team that attends biweekly. Our team consists of RN's and an MD-- the RN attends the rounds however. We receive about 1-2 cx's per week with this in place. I was curious as to lwmelhad's comments about referrals (or anyone else for that matter.) Who is on your team and what sort of suggestions are you offering, what types of services is your team actually providing? We are mostly doing goals of care cx's for pt's who are difficult to remove from vents and providing options for families who are faced with poor outcomes. We have done a few pain consults too.
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| Re:MANDATED CONSULTS (by ehargus on 10/30/2007)
I remember the days befor there was board certification in critical care---through any pathway: medicine, surgery, pediaatrics, or anesthesia ( I happen to be certified in Critical Care Medicine and Hospice and Palliative Care) thinking, "it sure will be great when we get a certification process in critical care medicine". Then ICU patients will get great care. ICU consults with intensivists will be mandated throughout the country and we will help lots of patients and save the health care system mega bucks. Most ICU's in this country probably do not even have mandated consults with intensivists (most community hospitals)and their attendings likely will balk at mandated palliative care consults. You see, academia is a world unto itself, but the power and control of a hospital unit is a battle gound only for the well armed. EH
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| Re:MANDATED CONSULTS (by lwmelhad on 10/31/2007)
SGray-we are a 5 hospital system; The hospital culture dictates consultative practice; the team at each hospital consists of ARNP and MSW. The physician/Medical Director is available as needed. The interdisciplinary team (IDT)consists of ICU physician, pharmacist, nutritionist, case manager, resp therapist, Infect. Control Coordinator, and myself and MSW. Each nurse reports on his/her patients. The needs/goals of the patient/family are identified by the nurse and IDT. We are consulted for: compassionate weans, psychosocial support, family conferences, decision making support: i.e., code status, health care surrogate/living will, aggressive vs. palliative tx option, education re: disease progression, prognosis, etc. We rarely are consulted for pain/symptom mgmt in ICU. In a slow week, we average 5-6 consults in my ICU. We also made our team available on weekends for the ICU.
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