Palliative Care Trigger Tool in the CVICU: A Needs Assessment

Background: Palliative care is a valuable resource that assists patients in determining their goals of care and end-of-life care preferences. Automated trigger tools can help to identify patients in the intensive care unit (ICU) who may benefit from palliative care. Problem: Several ICUs at the University of Utah Hospital actively utilize palliative care trigger tools, but no such tool exists in the Cardiovascular Intensive Care Unit (CVICU). Interventions: This QI project determined the need for a trigger tool for the CVICU patient population. Based on the needs assessment findings and evidence, the intent was to provide stakeholders' recommendations for a CVICU palliative trigger tool. Methods: The literature was reviewed to create an evidence-based trigger tool protocol for the patient population. A retrospective chart review (n=23) was conducted to collect data on the patients admitted to the CVICU between April 2022 and September 2022 who met palliative criteria during admission. The chart review was conducted for the previous six months after project approval. Data were managed in a detailed checklist and organized into tables to demonstrate findings. An executive summary addressed needs assessment findings, including chart review results, the evidence-based trigger tool protocol, and recommendations. Stakeholder feedback was obtained to assess usability, feasibility, and satisfaction. Results: The chart review (n=23) revealed that 30% (n=7) met palliative care criteria; in other words, they were flagged for being high risk. Of the total population, 53% (n=13) of the patients were deceased, and of the deceased patients, 85% (n=11) died in the CVICU with the remaining 15% (n=2) dying at home on hospice. Most providers (n=4, 80%) endorsed firm support of the tool's usability, feasibility and satisfactory with the tool and want to implement it in the CVICU. Conclusions: This chart review shows that 30% of cases met palliative care criteria, indicating a sustainable number of patients to flag for palliative consultation. The recommendation to implement an evidence-based trigger tool within the electronic health record in the CVICU was made to stakeholders based on the needs assessment findings.