Reflective Experiences on Integration of Palliative Care in the MICU at A Safety Net Hospital

Key Message : A recounting of the implementation of a palliative care bundle in a resource-limited MICU. Discussion of values of structured communication around prognosis and the systemic barriers limiting consistent integration. This pilot underscored the need for institutional commitment, beyond education alone, to meaningfully support patients, families, and staff in safety-net settings.

Abstract:

Background:
Highland Hospital’s Medical Intensive Care Unit (MICU) has high patient mortality and requires complex decision-making, which has created a clear need for palliative care in this setting; however, consistent integration remains a challenge. House staff voiced concerns about the minimal support available for communication in serious illnesses and representation of surrogate decision makers (SDM).

Objectives:
Pilot the implementation of a nationally recommended ICU Palliative Care Bundle followed by evaluation on its feasibility in a resource-limited safety net setting, followed by reflections on barriers, outcomes, and lessons learned.

Methods:
Between January to February 2024, a needs assessment was conducted via medical record review, house staff interviews, surveys, and observation during rounds. Between March to May 2024, a pilot was initiated implementing a modified ICU-Palliative Care Bundle emphasizing prognosis discussion, SDM identification, family meeting frequency, and improving the palliative care presence in the unit.

Results:
Feedback was overwhelmingly positive from MICU house staff, particularly with clarity around prognosis discussions, showing the value of an increased palliative care presence. Unfortunately, early identification of SDMs and timely family meetings were low and unchanged. Contributions to the results centered around limitations in staffing, competing clinical duties, and the reality of working in an overextended safety net hospital where manpower and system-wide support were insufficient to sustain meaningful changes.

Conclusion:
Although measurable outcomes did not shift, they revealed structural barriers and gaps in workflow integration. These findings showed that sustainable palliative care integration not only occurs on an educational level but on an institutional level as well. Reflecting on this experience, the lack of “positive” metric improvements was beneficial to show the opportunities for systemic support for seriously ill patients and their families in a safety new institution.

References: N/A