Field of Work: End-of-Life Care

Problem Synopsis: During the 1980s and 1990s, Americans began to be concerned about the long period of suffering many people endured before their deaths. According to researchers at the University of Washington School of Medicine (UWSM), about half of patients who die in hospitals receive care in an Intensive Care Unit (ICU) within three days of their death. One-third spend 10 or more days in the ICU during their final hospitalization.

Synopsis of the Work: From March 2003 to February 2007, with $371,150 from RWJF's Promoting Excellence in End-of-Life Care national program, researchers at the UWSM in Seattle created an intervention designed to improve the quality of end-of-life care in the ICU. Seven ICUs (medical, trauma, neurosurgical, surgical, coronary, burns and pediatric) at Harborview Medical Center, a 350-bed hospital within the University of Washington system, used the intervention.

Key Results: Project staff taught clinicians about the principles and practices of palliative care; selected and trained nurses, social workers, chaplains, doctors and respiratory therapists to serve as local champions; surveyed and interviewed staff in all seven ICU's to identify barriers to providing palliative care and to develop and implement solutions; surveyed families of survivors and decedents to ascertain their satisfaction with the care received; provided timely oral and written feedback to clinicians in areas such as pain rating, patient and family satisfaction, nursing satisfaction and quality of death and dying; and developed protocols and staff support to improve care and sustain the intervention.

In January 2005, Harborview created a 24-hour Palliative Care Consult Service comprised of clinicians and other hospital staff who respond to requests throughout the medical center. The neurosurgery department and the medical ICU began to train all staff in palliative care on a regular basis.

Key Findings: Project staff reported the following key findings:

• The average length of stay in the intensive care unit dropped from 7.16 days before the intervention to 5.83 days after patients enrolled in the intervention.
• Nurses reported that the quality of dying and death among patients enrolled in the intervention was higher than among patients who were not enrolled. Family members, however, did not give higher ratings to the experience of dying as a result of the intervention.
• Families of decedents were more satisfied with the care their loved one received than were families of survivors. Similarly, nurses indicated they were more satisfied with their ability to provide nursing care to patients that ultimately died than they were with their care to those who survived.