160 ‘Palliative critical care’: an important and transformative collaboration between palliative care and intensive care services at a large teaching hospital

Introduction In 2013, the Hospital Specialist Palliative Care (HSPCT) and General Intensive Care Unit (GICU) Teams began a quality improvement initiative in response to the palliative care needs experienced by GICU patients. ‘Palliative Critical Care’ now involves seamless inter-disciplinary working on an almost daily basis, supported by one session each per week of dedicated Intensivist and Palliative Medicine Consultant time. Here, we detail the impact of this collaboration on HSPCT activity and patient outcomes. Methods Retrospective review of HSPCT records between April 2013 and March 2019. Results Over the last 5 years the HSPCT has received 588 referrals from adult intensive care services (General, Cardiac and Neurological). From a baseline of 6 referrals in 2013/14 we now receive over 130 new referrals per year. Over this time our caseload has evolved; 79% of referrals for non-malignant conditions in 2018/19, compared with 59% in 2014/15. In both years the in-hospital mortality rate of patients seen by the HSPCT was approximately 50%. Key areas of impact include pain control, symptom control, family support in 66%, 81%, and 86% of interactions, respectively. Patients are given psychological support in 48% of interactions. The HSPCT also provide valued support to ICU staff in 32% of interactions and discharge advice in 19%. HSPCT involvement now routinely continues throughout the patient‘s hospital stay. The average number of contacts per patient has increased from 4.3 to 7.5 (2014/15 vs 2018/19, respectively), each contact lasting 30–40 minutes. Thus, the average total duration of HSPCT time per patient has increased from 139 minutes (2014/15) to 287 minutes (208/19). Conclusion This Quality Improvement Initiative has enabled a flourishing collaboration between our HSPCT and GICU teams resulting in a sustained increase in referral numbers from all adult ICU areas with more time dedicated to support each patient in a continuously evolving cohort.