Introduction: Each year more than half a million Americans die in or after ICU treatment and many others remain debilitated with severe functional and cognitive impairments. These growing numbers require more innovation within palliative care and have been identified as a healthcare priority. In 2006 after several years of research the care and communication bundle was published with support of many medical organizations. The bundle consists of identifing the medical decision-maker, determining advance directives and code status, distribution of a family information packet, regular pain assessment with optimal pain management, offering of social work and spiritual support and a interdisciplinary family meeting. Research has shown that consistent application of these elements has not occurred. Methods: In April of 2012 a intergrated multidisciplinary team was created to evaluate our compliance with the care and communication bundle. Our team was comprised of critical care physicians, nurse practitioners, physician assistants, nurses, a social worker, and an administrative assistant with data collection knowledge. The project occurred in a 18 bed Neurosurgical ICU in an 800 bed teaching and tertiary care center in New England. Results: The team performed a retrospective chart review over a 5 week period from April 2012-May 2012 to assess compliance with the bundle. There were 151 patients admitted during this period with 30 patients having length of stay >5 days. These charts were reviewed for identification of the medical decision-maker, determining advance directive status, investigation of resuscitation preference, distribution of family information leaflet, regular pain assessment, optimal pain management, the offering of spiritual support and social work, and the offering of a family meeting. The offering of social work support on day 3 was at 50% compliance and the offering of a family meeting on day 5 had 15% compliance. The team focused attention on those 2 elements of the bundle. The remaining elements had a compliance of 90-100%. The data collected was shared with all disciplines involved in care of the ICU patients. A survey of the ICU team was conducted as to barriers for compliance. Our unit social worker identified the lack of timely referrals and the medical providers identified the lack of social work involvement to establish these meetings, and losing track of patient's length of stay as barriers to compliance. Several providers also sighted that family meetings were occurring but there was inadequate documentation to capture these discussions. The administrative assistant for this team created a data sheet to allow tracking of patient's ICU length of stay and compliance with both social work and a family meeting being offered. She sent daily electronic mail to the unit social worker, ICU director, and chairs of the care and communication team to identify patients that were now day 3 and needed a social work consult and patients that were at day 5 and needed a family meeting offered. The medical team would then be asked to consult social services, and either social worker, staff nurse, or medical provider would offer a meeting to the patient and family. The care and communication team developed a standard note both paper and electronic for documentation of the family meeting. Retrospective chart reviews were performed for a 5 week period, 6 and 12 months after the start of these initiatives. Patient's charts with length of stay >5 days were reviewed. Patients' eligible were 58 of the 280 admissions during these time intervals. Social work was offered and involved 100% of the time at both reviews. Family meetings were offered 60% of the time at 6 month interval, and 80% at the 12 month interval. Conclusions: The creation of a intergrated multidisciplinary team improved daily compliance with care and communication bundle.