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Palliative Care and the ICU

Next Reply: Re:Mandated family meetings?
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Post Mandated family meetings?
Author: sgrommel
Date: Jun 18, 2008 2:27 pm
We provide palliative care consultation in a 700 bed private hospital. We have approximately 120 ICU beds and an open ICU model. In a hospital like ours, where physicians are paid for seeing patients, how would you incentivise or enforce physicians to conduct mandatory family meetings?
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+ Re:Mandated family meetings? (by SharolHerr on 06/18/2008)
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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