Abstract WP360: Use of a Care and Communication Bundle Can Improve Resource Utilization and Timeliness of Palliative Care for Severe Stroke Patients in the Neuroscience ICU

Abstract

Background: Severe stroke patients have immediate palliative care (PC) needs and communication between families and clinical teams has been identified as a gap in PC delivery. Delays in care planning can increase length of stay (LOS) and cost of care (COC) which decreases efficient resource utilization. Purpose: The purpose of this quality improvement project is to evaluate whether standardizing the communication process between families and treatment teams using a communication bundle validated in the medical ICU improves LOS, COC, and time to PC consultation in severe stroke patients in a neuroscience ICU. Methods: The Care and Communication Bundle (CCB) was prospectively implemented in 22 consecutive patients from February-April 2017 and compared to a control arm of 22 consecutive patients via retrospective chart review from February-April 2016. Improvement in resource utilization was defined as a decrease in LOS and COC. Patients with a primary diagnosis of ischemic or hemorrhagic stroke, NIHSS score of ≥ 15, and an expected ICU LOS of ≥ 5 days were included. Descriptive statistics were analyzed using Chi Square, Mann-Whitney U , or t- test where appropriate. Significance was set at p <0.05. Results: In the CCB group versus the control group, the median ICU LOS (2 vs 5.5 days, p =0.04), median hospital LOS (4 vs 9 days, p =0.02), and ICU COC ($21,118 vs $68,634, p =<0.01) were significantly lower. Documentation of code status (18 vs 9 patients, p =<0.01), advanced directives (21 vs 6 patients, p =<0.01), and family meetings (20 vs 13 patients, p =0.02) were significantly higher in the CCB group. The CCB group received earlier PC consults (1.5 vs 3.5 days, p =0.07). Conclusions: Standardizing communication between families and treatment teams significantly improved resource utilization and improved timeliness of PC delivery to severe stroke patients. Larger prospective studies of the CCB in severe stroke patients and within other neuroscience ICU populations are needed.