Initiating Early Palliative Care in the ICU: Integrating Critical and Supportive Care for a Unified Approach

Background: Adults are at the highest risk for chronic and serious illnesses that often result in intensive care unit (ICU) admissions. These individuals typically live with these conditions for the remainder of their lives. While curative treatments may not exist, palliative care offers a viable option to improve quality of life and potentially increase longevity. Early palliative care involvement—within 24 hours of ICU admission and during daily rounds—may enhance patient outcomes. The need for these services continues to rise with the aging population and increasing prevalence of non-communicable diseases.

Local Problem: Standardized palliative care screening within 24 hours of ICU admission is not routine practice. As a result, ICU patients and their caregivers often experience unmet and unrecognized needs during hospitalization.

Methods: The Model for Improvement (MFI) guided this Doctor of Nursing Practice (DNP) project. The Supportive and Palliative Care Indicators Tool (SPICT) was implemented using Plan-Do-Study-Act (PDSA) cycles to identify palliative needs within 24 hours of ICU admission. Pre- and post-implementation palliative care referral rates were compared, and Registered Nurse (RN) compliance with screening was measured.

Interventions: All ICU patients were screened for palliative needs within 24 hours of admission by the admitting RN. Patients who screened positive received an automatic referral to palliative care, eliminating provider discretion. Negative screenings prompted continued daily screenings until ICU discharge.

Results: Palliative Care referrals increased by 200%, from 20% to 60%, following implementation of the SPICT screening tool. RN screening adherence reached 90%, contributing to the rise in referrals.

Conclusion: Eliminating provider discretion and implementing a standardized screening tool led to a 200% increase in palliative care referrals, exceeding the project’s goal. This highlights the clinical impact of a structured palliative screening in the ICU. Integrating the SPICT tool into the electronic medical record (EMR) is recommended to enhance usability and ensure long-term sustainability in critical care settings.