“Bundle” of palliative care quality measures for ICUs
| Domain* | Measure | References† | Type of study | Specifications | |
|---|---|---|---|---|---|
| *Relevant quality domain as identified by the Critical Care Peer Workgroup of the Robert Wood Johnson Foundation’s Promoting Excellence in End-of-Life Care Project.22 Among seven such domains, our prototypical bundle addresses five; we do not directly address “Continuity of care” or “Emotional and organizational support for ICU clinicians.” Domains identified through direct investigation of patient and family views35,45,46 overlap with those described by the Critical Workgroup, but such studies did not focus on the ICU setting. | |||||
| †For each measure we cite supporting evidence (numbers correspond to reference list), classified by type: RCT, randomized controlled trial; OSI, observational study of intervention; OS, observational study showing need for improved palliative care; EX, peer reviewed expert consensus; REG, regulatory standard. | |||||
| ‡The day of ICU admission is considered day 0 and the following calendar day is day 1. | |||||
| ICU day 1‡ | |||||
| Patient/family-centred decision making | (1) Medical decision maker: Percentage of patients with documentation of status of identification of health care proxy (or other appropriate surrogate) | 22 47 | EX REG | Numerator: Number of patients with documentation of status of identification of health care proxy (or other appropriate surrogate) Denominator: Total number of patients admitted to the ICU within the last 24 hours | |
| Patient/family-centred decision making | (2) Advance directive: percentage of patients with documentation of advance directive status | 16, 17 48 | OS REG | Numerator: Number of patients with documentation of advance directive status Denominator: Total number of patients admitted to the ICU within the last 24 hours | |
| Patient/family-centred decision making | (3) Resuscitation status percentage of patients with documentation of resuscitation status | 16 22 | OS EX | Numerator: Number of patients with documentation of resuscitation status Denominator: Total number of patients admitted to the ICU within the last 24 hours | |
| Communication | (4) Family information leaflet: Percentage of patients whose families received information leaflet from ICU team member | 41 | RCT | Numerator: Number of patients with documentation that family received a written information leaflet from an ICU team member Denominator: Total number of patients admitted to the ICU within the last 24 hours | |
| Symptom management | (5) Regular pain assessment: percentage of 4 hour intervals with documentation of pain assessment | 49 50 | OSI REG | Numerator: Number of 4 hour intervals for which pain was assessed and documented using an appropriate rating scale Denominator: Total number of 4 hour intervals on days 0 and 1 (for patients admitted to ICU within the last 24 hours) | |
| Symptom management | (6) Optimal pain management: percentage of 4 hour intervals with documented pain score ⩽3 on 1–10 scale | 49 50 | OSI REG | Numerator: Number of 4-hour intervals for which pain score was ⩽3 on 1–10 scale (or equivalent) Denominator: Total number of 4-hour intervals on days 0 and 1 (for patients admitted to ICU within the last 24 hours) | |
| ICU day 3 | |||||
| Emotional and practical support for patients/families | (7) Social work support: percentage of patients with documentation that social work support was offered to the patient/family | 14, 51 22 | OS EX | Numerator: Number of patients with documentation that social work support was offered to the patient/family Denominator: Total number of patients with ICU length of stay ⩾3 days | |
| Spiritual support for patients/families | (8) Spiritual support percentage of patients with documentation that spiritual support was offered to the patient/family | 22 52 | EX OS | Numerator: Number of patients with documentation that spiritual support was offered to the patient/family Denominator: Total number of patients with an ICU length of stay ⩾3 days | |
| ICU day 5 | |||||
| Communication | (9) Interdisciplinary family meeting: percentage of patients with documentation of an interdisciplinary meeting with the patient/family | 14 42 | OS OSI | Numerator: Number of patients with documentation that an interdisciplinary family meeting was held with the patient/family Denominator: Total number of patients with an ICU length of stay ⩾5 days | |
| Communication | (10) Family meeting room: dedicated space for meetings between clinicians and ICU families | 15 52 | OS OS | Periodic Point Measurement: Presence or absence of room designated for family meetings | |