APRN led patient-centered communication for goal concordant care
Nature and scope of the project
Patients in the Medical Intensive Care Unit (MICU) at Stroger Hospital face complex medical, psychosocial, and spiritual needs, often with high mortality risks and no advance directives. They frequently undergo aggressive End-Of-Life (EOL) interventions, causing unnecessary suffering. Integrating palliative care in ICUs improves communication, reduces ICU length of stay (LOS), and promotes patient-centered care.
Synthesis and analysis of supporting literature
Studies confirm that integrating palliative care services in ICUs enhances communication, collaboration, patient-centered care, and reduces LOS (Philips et al., 2024; Janczewski et al., 2024; Roodbeen et al., 2020).
Project implementation
This APRN-led quality improvement project, conducted from 08/01/2023 to 08/01/2024, aimed to increase documented advance directives and life-sustaining treatment (LST) discussions in the EMR by 50%. Education was provided to MICU nurses and physicians. Collaborative family meetings aligned care plans with informed decisions. Data was collected monthly.
Evaluation criteria
Pre- and post-intervention chart reviews assessed palliative care consultations, advance directives, code status, and goal-concordant care documentation over 12 months.
Outcomes
Nurses identified complex patients during rounds, increasing palliative care consultations (71 to 329), advance directive documentation (16 to 325), DNR code status changes (12 to 229), and transitions to comfort-focused care (21 to 104). Outcomes included reduced LOS, increased hospice referrals, and improved patient-family satisfaction. Documented advance directives and goal-concordant care increased by 99.3% and 100%, respectively.
Recommendations
This initiative enhanced communication, collaboration, and value-based care, reducing ICU interventions and improving EOL care. Nurses play a critical role in recognizing palliative needs, advocating for patient-centered care, and fostering informed decisions while minimizing non-beneficial interventions.
References
Janczewski, L. M., Chandrasekaran, A., Abahuje, E., Slocum, J., et al. (2024). Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study. Critical Care Medicine 52(6): p e289-e298. | DOI: 10.1097/CCM.000000000000623
Philips, T. N., Gormley, D.K., Donaworth, S. (2024). Integrating palliative care screening in the intensive care unit: A qualitative improvement project. Critical care nurse, (44) 2.
Roodbeen, R., Vreke A, Boland, G., Rademakers, J., et al. (2020). Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PLoS ONE 15(6): e0234926. https://doi.org/10.1371/journal.pone.0234926
APRN led patient-centered communication for goal concordant care
