Improving Relationships: Initiating a Collaborative Project Between the Neurosurgical Care Unit and Palliative Care Unit (QI830)

Abstract

•Demonstrate the necessity and benefits of Palliative collaboration in the identification and treatment of neurocritically ill patients who would benefit from palliative medicine.•Understanding the importance of interdisciplinary collaboration in fulfilling standards set through quality palliative metrics. Of the more than 500 patients admitted to the Palliative Care Unit (PCU) at North Shore University Hospital (NSUH) in 2016, only 84 (16%) were from the Neurosurgical Care Unit (NSCU). Preliminary data indicated that most of those 84 patients were seen within one week of hospitalization, but many expired within 24 hours of transfer. Many of these patients (and their families) could have benefitted from the services offered by our Geriatric and Palliative (GAP) team. The goals of this project are to 1) collaborate with the NSCU team to identify patients and families who could potentially benefit from a palliative consult early in their hospital stay, and 2) to assess the impact of this collaboration on quality palliative metrics. A GAP Nurse Practitioner began attending a bi-weekly morning huddle with the NSCU team. Automatic triggers included patients with an ICH score > 4, but any patient deemed a potential beneficiary was seen by the GAP team. 29 consults were requested in June, 3 of which were triggered by ICH score > 4. Of those 29 patients, 17 were transferred to the PCU for end of life care. Days-to-Consult dropped from an average of 5.3 in 2016 to 4.2 in June 2017. Consult-to-Transfer days dropped from 4.6 in 2016 to 2.3 in June 2017. The automatic trigger of ICH score > 4 has become ancillary to the project as the presence of a GAP team member within the interdisciplinary team in the NSCU has proved the greatest benefit. The GAP-NSCU huddle has been enormously successful in early identification of neurocritically ill patients who would benefit from palliative consultation. In just a single month we have transferred 17 NSCU patients, after transferring 48 all of last year.