Improving Timeliness of Palliative Care Referrals Within the ICU: A Quality Improvement Project

Document Type

Peer-Reviewed Article

Publication Date

2026

Abstract

Background: The ICU often provides aggressive treatments that may be futile for critically ill patients. Palliative care (PC) aims to enhance the quality of life for patients with life-threatening illnesses. Despite recommendations for early PC consultations, delays remain prevalent worldwide.

Objective: This project aimed to improve the timeliness of PC referrals in a New York City hospital ICU through the implementation of a nurse-driven PC screening tool.

Methods: Using the Model for Improvement, this quality improvement project was conducted over 7 months, including a 4-month baseline phase and a 3-month implementation phase. ICU nurses used a PC screening tool to evaluate patients within 48 hours of admission. The project aimed to increase PC screenings to 75% and ensure PC referrals within 48 hours.

Results: The implementation phase saw a significant increase in PC screenings, with compliance reaching 90.9% after process adjustments. The average time to PC referral decreased from 8.9 days pre-intervention to < 2 days in the 3-month implementation phase. Of the patients receiving PC consultations, 46.6% had do not resuscitate and/or intubate status established, and 20% transitioned to hospice or comfort care.

Conclusions: The nurse-driven PC screening tool effectively improved the timeliness of PC referrals, demonstrating the importance of standardized screening processes in the ICU.

Comments

Fiore, S., O'Donovan, S., & Milner, K. A. (2026). Improving timeliness of palliative care referrals within the ICU: A quality improvement project. Dimensions of Critical Care Nursing, 45(2), 103–110.Doi: 0.1097/DCC.0000000000000747

DOI

10.1097/DCC.0000000000000747

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