• Claire J Creutzfeldt, Ruth A Engelberg, Larry Healey, Chong Sherry Cheever, Kyra J Becker, Robert G Holloway, and J Randall Curtis.
• 1Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA. 2Department of Pulmonary and Critical Care, University of Washington, Seattle, WA. 3Department of Neurocritical Care, University of Washington, Seattle, WA. 4Department of Neurology, University of Rochester, Rochester, NY.
• Crit. Care Med. 2015 Aug 1;43(8):1677-84.

ObjectivesPatients admitted to the neurological or neurosurgical ICU are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs.DesignQuality improvement project using a parallel-group prospective cohort design.SettingSingle neuro-ICU at a large, academic medical center.PatientsAll patients admitted to the neuro-ICU from September 1, 2013, to November 30, 2013.InterventionsWe developed a palliative care needs screening tool consisting of four questions: 1) Does the patient have distressing physical or psychological symptoms? 2) Are there specific support needs for patient or family? 3) Are treatment options matched with patient-centered goals? 4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for one of two neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening.Measurements And Main ResultsOver the 3-month period, 130 patients were admitted to the service with screening and 132 patients to the service without screening. The two groups did not differ with regard to age, gender, Glasgow Coma Scale, or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p = 0.019) and a trend toward more palliative care consultations (p = 0.056).ConclusionsWe developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.

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