ICU: Integrating Palliative Care
All intensive care unit (ICU) patients and their families stand to benefit from palliative care services via referral for consult by the palliative care team and/or delivery of core palliative care services by trained ICU staff. Ideally, these models occur in parallel.
This toolkit was developed and curated by the Advisory Board of IPAL-ICU (Improving Palliative Care in the ICU) in an effort to increase access to palliative care services for patients in the ICU and their families.
What’s in the Toolkit
Introduction to Palliative Care in the ICU
The "what and the why" of ICU palliative care, including standards for ICU palliative care and how to make the case.
Rationale and data for integrating palliative care in the ICU.
IPAL-ICU report leveraging expertise in critical care and palliative care to address symptom management challenges.
Two models used successfully to integrate and improve palliative care in the ICU.
National recommendations and guidelines to improve palliative care in the ICU.
How rapid response teams can foster discussions about achievable goals of care and address emergent palliative care needs of patients and families.
Specific challenges, strategies, and solutions for the surgical intensive care unit.
Exploration of the roles of palliative care and ICU teams in advance care planning.
Program Design
Practical guidance on model design and tools for identifying patients in the ICU who would benefit from palliative care.
Practical steps to start a successful, enduring initiative that will improve palliative care for critically ill patients and their families.
Guidance on needs assessment, screening criteria selection, implementation planning, and evaluation.
CAPC consensus report for identification of patients with palliative care need. 2011.
Sample palliative care screening tool for ICU patients. Shared by Mount Carmel Health.
Sample agreement between palliative care and ICU teams defining palliative care referral criteria, palliative care scope of practice for ICU patients, and communication protocols between clinical teams. Shared by the John D. Dingell VA Medical Center.
Strategies and limitations of prognostication for neurocritically ill patients.
Sample Policies and Clinical Tools
Tools for both palliative care and ICU teams to assess need, conduct family meetings about priorities for care, and provide services in the ICU.
Shared by Northwell Health (formerly North Shore Long Island Jewish).
For use by ED staff. Shared by Froedert Hospital, Medical College of Wisconsin.
10-step guide including recommended phrases for the clinical team. Shared by Mount Sinai Hospital.
Communication framework for discussing goals of care with families of patients in the ICU.
Shared by Froedert Hospital, Medical College of Wisconsin, 2007.
A compassionate process for removing mechanical ventilation (RMV) in the dying patient. To be used when death is the expected outcome following RMV. Shared by Froedert Hospital.
Sample policy for palliative screening and assessment by ICU staff. Shared by Mount Carmel Health.
Strategies and limitations of prognostication for neurocritically ill patients.
Quality Measurement Tools
Measurement strategies to evaluate patient, family, and clinician satisfaction with services, in support of ongoing quality improvement.
Quality measures for palliative care in ICU settings, and using measurement to guide QI.
Assess referrer satisfaction with palliative care. Shared by the VA Ann Arbor Healthcare System.
Assess ICU physician satisfaction with palliative care. Shared by the University of Washington School of Medicine.
Assess ICU nursing satisfaction with palliative care. Shared by the University of Washington School of Medicine.
NPCRC provides measurement and evaluation tools for research, including pain and symptom management, functional status, psychosocial care, caregiver assessment, and quality of life.
Clinical Training Resources
Training ICU teams in communication skills and family caregiver support, including CAPC’s online CE curriculum on communication skills for clinicians from all disciplines.
Online training curriculum for all specialties and disciplines to strengthen their care of patients living with serious illness. Free continuing education credits for all, and physicians receive ABIM MOC credits for select courses.
IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the ICU) is a quality improvement and professional development program to integrate palliative care into the ICU by training and supporting bedside nurses. The free online toolkit includes videos that illustrate the crucial roles of bedside nurses in ICU palliative care and serious illness communication. Downloadable and printable guides facilitate use of the videos for self-study, education sessions, and as part of institutional improvement projects.
A train-the-trainer program, held once or twice annually at a specific location, covering eight curriculum modules. Participants receive up-to-date resources for teaching at their home institutions.
Educating Social Workers in Palliative and End-of-Life Care (ESPEC) is an innovative training program designed for health social workers by social workers to promote the integration of primary palliative care skills into clinical practice.
Information for Patients and Families
Online information and sample materials developed by ICUs nationwide to explain the role and benefits of palliative care to patients and families.
Information for patients and families about palliative care.
Sample handout used to explain the role and function of the palliative care team to ICU patients and their families. Shared by Mount Carmel Health.
Guide to help families prepare for a meeting with the clinical team. The intent is to make ICU family meetings more effective and efficient. Developed by Veterans Integrated Service Network 3.
Reference Library and IPAL Advisory Council
Relevant publications for integrating palliative care in the ICU.
Relevant literature for palliative care-ICU integration.
Members of CAPC's IPAL-ICU Advisory Council, which co-authored many of the resources in this toolkit.
