Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. An ambassador program and expanded visiting hours turned the waiting room into part of the therapeutic environment. New palliative order sets and practice guidelines were introduced. Interdisciplinary care planning was guided by a family communication record. Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.

PURPOSE: Instruments to evaluate patient/family care and satisfaction at the end-of-life in an intensive care unit (ICU) are limited. The Quality of Dying and Death Questionnaire (QODD) and the Critical Care Family Satisfaction Survey (CCFSS) are tools that have been validated in different populations. The goal of this study was to correlate the results of the Family and Nurse QODD and CCFSS for patients who died in a multi-specialty ICU.