Promoting Palliative Care Excellence in Intensive Care Demonstration Projects

Lehigh Valley Hospital and Health Network
Massachusetts General Hospital and Harvard Medical School
New Jersey Medical School
University of Washington Schools of Medicine and Nursing

In March 2003, four health care institutions from around the country received grants totaling nearly $1.5 million for developing innovative ways of integrating high-quality palliative care services in critical care settings. The four demonstration projects developed palliative care models for ICUs and assessed the impact on the quality of care for patients and their families. The grantees enhanced care across the spectrum of Medical, Surgical, Trauma, Acute Care, Burn, Coronary and Pediatric ICUs.

Promoting Excellence in End-of-Life Care, a national program of the Robert Wood Johnson Foundation, selected grantees for 3-year projects from a highly competitive pool of 242 applicants responding to the "Promoting Palliative Care Excellence in Intensive Care" call for proposals. All projects had co-principal investigator teams comprised of a nurse and a physician.

Although many Americans receive highly skilled, state-of-the-art care in ICUs, experts increasingly recognize that critically ill patients can also benefit from palliative services. All four of the projects selected proposed comprehensive, coordinated approaches to patient care in ICUs that included team-based care planning involving the patient and the family, attention to spiritual comfort and psychosocial support for patients and families and bereavement support for families of patients who die.

Ira Byock, M.D., a pre-eminent palliative care physician at Dartmouth Medical School and Director of the Promoting Excellence in End-of-Life Care national program, explained the need for the demonstration projects, "For too long, critical care and palliative care have been viewed as polar opposites. In reality, the science and skills of both disciplines are needed to provide optimal care for critically ill or injured patients and their families."

Each project suggested a cultural change in critical care settings that fused palliative care into existing practice patterns, and included educating ICU staff and embedding palliative care practice in daily hospital routines. Projects were:

  • Lehigh Valley Hospital and Health Network, Allentown, PA
    A palliative care model implemented in three ICUs (Medical ICU, Surgical ICU and Acute Care Unit) in a community hospital in rural Pennsylvania. The project included a well-developed educational component for clinicians and students from the hospital and the community.
  • Massachusetts General Hospital and Harvard Medical School, Boston, MA
    The merging of a well-established palliative care program with a Medical ICU in an urban, tertiary care teaching hospital affiliated with Harvard Medical School in Boston.
  • University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, N.J.
    A collaboration between a university hospital and medical school to develop and implement an exportable model of palliative care in an inner city academic medical center Trauma/Surgical ICU, where familiar palliative care models do not fit the clinical realities of a trauma/surgical center.
  • University of Washington Schools of Medicine and Nursing, Harborview Medical Center, Seattle, WA
    The introduction of interdisciplinary palliative care services in seven distinct ICUs (Medical, Trauma, Neurosurgical, Burn, Surgical, Coronary and Pediatric) in a multi-cultural county hospital within the University of Washington system.

"This Promoting Excellence initiative sought to integrate attention to comfort and quality of life within state-of-the-art critical care," says Byock. "In so doing, we hoped to elevate best practice standards of critical care to a new plane. The enthusiastic response to the call for proposals was evidence of the strong commitment among leaders in critical care to advance the human values of comfort and emotional and spiritual caring within the high-tech environment and high-pressure pace of ICU practice.

Also see: Critical Care Workgroup
Managing Death in Intensive Care Units

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.