Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback

Title

Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback

Creator

Nelson JE; Mulkerin CM; Adams LL; Pronovost PJ

Publisher

Quality & Safety in Health Care

Date

2006

Subject

Humans; United States; Pain Measurement; Professional-Family Relations; Cooperative Behavior; Communication; Pilot Projects; Program Development; Patient Satisfaction; Spirituality; Hospitals; Proxy; Feedback; decision making; Health Care; Quality Assurance; Health Care/organization & administration; Quality Indicators; Palliative Care/psychology/standards; Intensive Care Units/standards; Critical Care/psychology/standards; Voluntary/organization & administration/standards

Description

OBJECTIVE: To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). DESIGN: Use of an interdisciplinary iterative process to create a prototype "bundle" of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. SETTING: The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. PATIENTS: Critically ill patients in ICUs for 1, > 3, and > 5 days. MEASUREMENTS AND MAIN RESULTS: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of > 100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician-patient/family communication and other key components of ICU palliative care. CONCLUSIONS: The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity.
2006

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

264-271

Issue

4

Volume

15

Citation

Nelson JE; Mulkerin CM; Adams LL; Pronovost PJ, “Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback,” Pediatric Palliative Care Library, accessed July 31, 2021, https://pedpalascnetlibrary.omeka.net/items/show/13418.

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