• Natalie S McAndrew, Colleen McCracken, Aniko Szabo, Balaji Narayanan, Wendy Peltier, and Jane Leske.
• Natalie S. McAndrew, PhD, RN, ANCS-BC, CCRN-K, is an assistant professor in the College of Nursing at the University of Wisconsin-Milwaukee and a Nurse Scientist at Froedtert & the Medical College of Wisconsin, Froedtert Hospital in Milwaukee. Dr McAndrew's program of research focuses on developing, testing and translating interventions to increase collaborative palliative care for patients and their families in acute and critical care. Colleen McCracken, BSN, RN, CMSRN, CHPN, OCN, is a nurse educator for an inpatient oncology and palliative care unit at Froedtert Hospital in Milwaukee. As a palliative and hospice expert she focuses on improving patient access to these services and supporting high quality palliative and hospice nursing care. Aniko Szabo, PhD, is an associate professor and director of the Biostatistics Consulting Service at the Medical College of Wisconsin in Milwaukee. Dr Sabo's research interests are in statistical modeling of biomedical data. She collaborates with biomedical investigators across the entire spectrum of translational research. Balaji Narayanan, MS, IE, is a process improvement leader and Six Sigma Black Belt at Froedtert Hospital in Milwaukee. Mr. Narayanan is interested in supporting the growth of palliative and hospice care within healthcare organizations. Wendy Peltier, MD, is an associate professor of Medicine at the Medical College of Wisconsin and Section Head of the Palliative Care Center in the Division of Hematology and Oncology. Dr Peltier has extensive background in medical education, leadership and neuromuscular neurology. She is interested in the development of models for 'upstream' palliative care in serious illness and inpatient hospice for critically ill patients. Jane Leske, PhD, RN, ACNS-BC, FAAN, is professor Emerita at the University of Wisconsin-Milwaukee College of Nursing and a Nurse Scientist at Froedtert Hospital in Milwaukee. Dr Leske is well known for her 30-year history of research focused on family needs in the ICU. Her research has been central to changes in the care for families of critically ill individuals worldwide.
• Dimens Crit Care Nurs. 2020 Jul 1; 39 (4): 219-235.

BackgroundThere is evidence that palliative care and floating (inpatient) hospice can improve end-of-life experiences for patients and their families in the intensive care unit (ICU). However, both palliative care and hospice remain underutilized in the ICU setting.ObjectivesThis study examined palliative consultations and floating hospice referrals for ICU patients during a phased launch of floating hospice, 2 palliative order sets, and general education to support implementation of palliative care guidelines.MethodsThis descriptive, retrospective study was conducted at a level I trauma and academic medical center. Electronic medical records of 400 ICU patients who died in the hospital were randomly selected. These electronic medical records were reviewed to determine if patients received a palliative consult and/or a floating hospice referral, as well as whether the new palliative support tools were used during the course of care. The numbers of floating hospice referrals and palliative consults were measured over time.ResultsAlthough not significant, palliative consults increased over time (P = .055). After the initial introduction of floating hospice, 27% of the patients received referrals; however, referrals did not significantly increase over time (P = .807). Of the 68 patients who received a floating hospice referral (24%), only 38 were discharged to floating hospice. There was a trend toward earlier palliative care consults, although this was not statistically significant (P = .285).ConclusionThis study provided the organization with vital information about their initiative to expand end-of-life resources. Utilization and timing of palliative consults and floating hospice referrals were lower and later than expected, highlighting the importance of developing purposeful strategies beyond education to address ICU cultural and structural barriers.

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