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Palliative Care and the ICU

Next Reply: Re:Palliative Care and Trauma Service Integration
Previous Message: comfort care

Post Palliative Care and Trauma Service Integration
Author: jstoneberg
Date: Oct 23, 2008 11:46 am
I am embarking on a project with our trauma service to integrate palliative care for those patients in greatest need. Does anyone have any guidelines or protocols that they might use to trigger a palliative care consultation for a select portion of trauma patients that may receive the greatest benefit? I am curious to know what other palliative care services experience has been when working with trauma patients. Any information would be greatly appreciated.

Regards,
Jeff Stoneberg, DO
Replies: order by [Date] [Author] [Subject]
Re:Palliative Care and Trauma Service Integration (by Deb on 10/23/2008)
Hi, I am an ex-SICU/trauma nurse and so when I went into palliative care they knew me well and I was able to insinuate myself pretty easily. I presented on PC a few times and I attended rounds with the trauma team and went to many Interdisciplinary family meetings and was able to have my perspective heard by team and family. I am now frequently called by the trauma team. We have not written any guidelines or protocols, but pretty much any trauma pt whose injury may not be survivable or will significantly chg their quality of life, such as severe head injuries. The older pt on coumadin who falls and has a bleed- or even just advanced age and a fall....I go in and discuss goals of care and educate on possible implications of choices such as need for SNF and feeding tubes etc...One trauma surgeon the other day bragged to me that on the weekend when I was off he had implemented my comfort care order set for a trauma pt who was dying. So I guess it is sinking in...
Re:Palliative Care and Trauma Service Integration (by kkerr on 11/21/2008)
Hello, There is an interesting article describing outcomes associated with implementing a structured palliative care intervention in a trauma ICU: Changing the Culture Around End-of-Life Care in the Trauma Intensive Care Unit Anne C. Mosenthal, MD. et al The Journal of TRAUMA Injury, Infection, and Critical Care The same group published a paper describing their intervention: Mosenthal AC, Murphy PA. Interdisciplinary model for palliative care in the trauma/surgical ICU. Robert Wood Johnson Foundation demonstration project for improving palliative care in the ICU. Crit Care Med. 2006;34:S399 –S403 Not sure this gets at the issue of identifying which patients are in greatest need, but it shows one method of ensuring that trauma patients and their families benefited from a palliative care intervention. Best wishes in your efforts, Kathleen Kerr Senior Analyst University of California San Francisco Palliative Care Leadership Center

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