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Palliative Care and the ICU

In Reply To: Mandated family meetings?
Next Reply: Re:Re:Mandated family meetings?

Post Re:Mandated family meetings?
Author: SharolHerr [CAPC/PCLC Faculty]
Date: Jun 18, 2008 3:56 pm
A large component of acute palliative care services' success has been their willingness, skill and availability to conduct family meetings. The skill level of the palliative professionals can facilitate decision making and establishment of goals of care. For employed physicians in the ICU the imperative could be for recognizing indicators for making palliative consults. This can off-load some of the intense family interactions and make them available to see more patients and focus on the ICU issues. A possibility is to establish quality and financial outcomes that could be measured to evaluate the employed physician. There are a wealth of elements that could be evaluated such as documentation of advanced directives, establishing DNR, goals of care discussions, interdisciplinary collaboration, outcomes post intubation, LOS in ICU, etc. Triggers for consult could include: LOS in ICU, presence of multi-organ system failure, # of consultants, request for trach or PEG placement, etc. The key is to link practice with measurable outcomes. Sharol Herr, RN, MSEd, CHPN; Palliative Nurse Clinician/Education Coordinator; Mt. Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
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+ Re:Re:Mandated family meetings? (by TerrellVanAkenMD on 06/18/2008)
One of the reasons that palliative care services provide an excellent resource is the continuity provided by the palliative care team compared to a continually shifting hospitalist service. As medical director of our relatively small service for palliative care I do provide an advantage in knowing the family and the clinical history often even better than the hospitalist who rotates off each week. However, I must tell you I have anxiety when it comes to thoughts of decreasing the LOS for the ICU when we are a small hospital system and a number of the cases have been incredibly stressful, incredibly lengthy, gut-wrenching cases with prolonged ventilator care, unrealistic family expectations (inspite of numerous family meetings explaining prognosis and poor quality of life), nursing frustration and burnout, etc. I KNOW I have helped in a number of much shorter stays where everything went well and palliative care really did work. But it's the FEW cases with incredibly long lengths of stays and bioethical dilemmas that remain at the forefront of my and everyone else's thoughts. I do believe the palliative care service is appreciated (our first real survey is just going out) but sometimes numbers might not reflect it (ala LOS.) Terrell B. VanAken, M.D., Medical Director, NorthBay Bridges/A Palliative Care Service of NorthBay HealthCare.

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