Promoting Excellence : Promoting Palliative Care Excellence in Intensive Care : Massachusetts General Hospital and Harvard Medical School

Updated September 2005

Grantee:
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Project Overview:

Title: Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit

The Massachusetts General Hospital and Harvard Medical School project is utilizing program grant funds to merge a well-established palliative care program with a Medical Intensive Care Unit (ICU) at Massachusetts General Hospital (MGH). MGH is a 900-bed (with 122 ICU beds) urban, tertiary care teaching hospital with Magnet hospital status affiliated with Harvard Medical School. MGH is a Level 1 Trauma Center.

The MGH Palliative Care Service (PCS) is one of the most experienced palliative care teams in the country. Members of the PCS team joined with other clinicians at the hospital to form an interdisciplinary leadership team that is introducing patient and family centered palliative care practices into the Medical ICU and merging palliative care and critical care cultures.

Co-Principal Investigators for the project are J. Andrew Billings, M.D., and Adele Keeley, R.N. Dr. Billings describes their model, "We are identifying, piloting and evaluating a series of practical, transferable and measurable interventions that will assure greater attention to the physical, psychosocial and spiritual suffering of all patients admitted to the Medical Intensive Care Unit and their families." All health professionals, as well as health profession students, are exposed to palliative care practice, with the existing PCS serving as trainers and consultants. Cross training between the Palliative Care Service staff and ICU staff will assure training for the palliative care staff in the culture and practice of critical care medicine. The training includes, "role modeling about palliative care and relevant communications skills," Billings explains.

Project Goals are:

• Improve and standardize physical and psychosocial/spiritual end-of-life care in the institution;
• Strengthen staff education and support programs so that staff have access to state-of-the-art palliative care; and
• Generate, publish and otherwise disseminate useful evaluation data about transferable improvements.

Project Intervention Components:

• Recruitment and training of Palliative Care Nurse Champions;
• Development of Palliative Care Curriculum and Tools;
• Palliative Care Grand Rounds;
• Study Procedures and Evaluation:
  • Chart abstractions;
  • Questionnaires for families;
  • Clinical education surveys for nurses and physicians;
  • Quality of death survey for nurses; and
  • Quality of death survey for families.

Tools:

Resources:

Related Resources:

Lessons Learned:

Team Members:

J. Andrew Billings, M.D., Principal Investigator
Director, Palliative Care Services
Massachusetts General Hospital

Adele Keeley, R.N., Principal Investigator
Nurse Manager, Medical ICU
Massachusetts General Hospital

Joel Bauman, M.D.
Staff Physician, Palliative Care Service
Massachusetts General Hospital

Alexandra Cist, M.D.
Pulmonary/Critical Care & Clinical Ethics
Massachusetts General Hospital

Edward E. Coakley, R.N.
Project Advisor
Director Emeritus
Massachusetts General Hospital

Catherine Graham, M.Des.
Senior Clinical Research Coordinator
Palliative Care Service
Massachusetts General Hospital

Mary Coughlan Lavieri, R.N., M.S.N., CCRN
Palliative Care Resource Nurse
Medical Intensive Care Unit
Massachusetts General Hospital

B. Taylor Thompson, M.D.
Director, Medical ICU
Associate Professor of Medicine
Pulmonary and Critical Care
Massachusetts General Hospital

Marilyn G. Wise, M.S.W., LICSW
Clinical Social Worker
Medical Intensive Care Unit
Massachusetts General Hospital

Contact Information:

J. Andrew Billings, M.D., Principal Investigator
Director, Palliative Care Services
Massachusetts General Hospital
55 Fruit Street, Founders 600
Boston, MA 02114
Ph: 617.724.9197
Fax: 617.724.8693
jbillings@partners.org

Adele Keeley, R.N., Principal Investigator
Nurse Manager, Medical ICU
Massachusetts General Hospital
Blake 7 MICU
Boston, MA 02114
Ph: 617.726.2594
Fax: 617.724.8410
akeeley@partners.org

Web sites:
www.massgeneral.org/palliativecare/
www.hms.harvard.edu/cdi/pallcare/
www.mgh.harvard.edu/

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Promoting Excellence in End-of-Life Care is 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. Visit PromotingExcellence.org for more resources.