The Art of Healing: Transforming Intensive Care Unit Care Delivery Using a Compassionate Care Approach

TaShauna McCray, DNP, RN

Disclosures

Journal of Hospice and Palliative Nursing. 2016;18(1):29-38. 

In This Article

Abstract and Introduction

Abstract

Care provided to seriously ill patients at the end of life is viewed as a significant indicator of health care quality. Many patients with serious illnesses are admitted to an intensive care unit, where the primary focus is on reversing or controlling illnesses. This can result in decreased patient satisfaction, unnecessary testing, and poor symptom management. This study monitored the patient satisfaction, length of stay, variable costs, and mortality and readmission rates of seriously ill patients at a small community hospital. The patients had been admitted to a medical-surgical intensive care unit (MSICU) where end-of-life palliative care consultative services were absent. The purposes of this quality improvement study were to (a) develop and implement a robust palliative care program for intensive care patients at a small community hospital and (b) evaluate whether the study approach was successful in improving care delivery at the end of life. The primary focus was for the compassionate care team to provide an added support to patients at the end of life. An evaluation of the data suggested the need for early palliative care consultations to improve program effectiveness.

Introduction

Currently, 90 million Americans live with a serious illness, and this number is expected to more than double over the next 25 years. Equally important, however, is the fact that many patients with serious illnesses are admitted to intensive care units (ICUs) where a primary focus is placed on reversing or controlling illnesses.[1] Studies suggest that more than 540 000 deaths per year take place in ICUs throughout the US health care systems, accounting for approximately 20% of all deaths nationwide, which demonstrates a continued gap in care delivery at the end of life.[2,3] It is estimated that by the year 2030 20% or 72.1 million Americans will be older than 65 years, which has more than doubled since 2000.[4] So what does this mean for hospitals and health care systems? The aging of Americans, coupled with other disabilities, including frailty, functional limitations, physical and cognitive disabilities, and increased instances of serious illness, is rising, resulting in increased ICU admission rates, lengths of stay (LOSs), readmission rates, total care delivery costs, and inpatient mortality rates.[5,6]

Despite the increased prevalence of patients with serious illnesses and increased ICU admissions, studies suggest that most patients experience poor symptom management, disintegrated care, insufficient emotional support, provider-family conflict, and poor communication.[3,7,8] Increased concerns about access to care and health care expenditures following the enactment of the Affordable Care Act have urged many health care organizations to explore innovative ways to decrease costs while maintaining efficiencies.[9] This quality improvement study depicts one organization's use of a compassionate care team (CCT) to improve the patient experience and the quality of care delivery at the end of life while decreasing resource utilization and preventing cost increases.

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