Hospital and Program Description

Good Samaritan Hospital Medical Center is a 537-bed MAGNET designated community hospital, located in West Islip, New York. The Palliative Care Program is a consultation service supported by an interdisciplinary team providing acute palliative care in a dedicated 11-bed acute palliative care unit and throughout the hospital.

Problem

GSHMC Critical Care Unit functions as an “open” unit, which leads to each patient having multiple consultations during their stay. Working within this compartmentalized type of care, family conferences and open communication between disciplines is very difficult to obtain. It was noted that though the need for Palliative Care would be of greatest benefit to this patient population, it was our lowest referring unit.

Processes to resolve problem

To initiate a culture change it was imperative to establish a h3 palliative care presence within the unit. Steps to accomplish included:
1) Identify a unit-based “Nurse Champion” certified in Hospice and Palliative Care
2) Weekly family support group initiated; this introduced the philosophy of palliative
care to families.
3) Palliative care education of staff, physicians and Critical Care Committee
4) Representation on the Critical Care Committee
5) Participation of the Palliative Care team in daily interdisciplinary collaborative care rounds.

Outcomes

Nurse/ physician knowledge and understanding of palliative care resulted in increased referrals leading to decreased length of stay, increase in transfers to more appropriate levels of care, and improved patient and family satisfaction. Also, noted was a more collegial partnership between the Critical Care and Palliative Care providers working together to establish and support goals of care.

Lessons Learned

Education and understanding of palliative care among the health care team is essential for best outcomes for patients. Open ICUs present unique obstacles to delivery of palliative care services.