Promoting Excellence : Promoting Palliative Care Excellence in Intensive Care : New Jersey Medical School

Updated September 2005

Grantee:
University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey

Project Overview:

Title: Interdisciplinary Model for Palliative Care in the Trauma/Surgical ICU

The University of Medicine and Dentistry of New Jersey, New Jersey Medical School (UMDNJ) project is developing an exportable model of palliative care in trauma/surgical intensive care, a new arena for palliative care services. The project will develop and implement the model at University Hospital, a 446-bed academic medical center on the Newark campus of the University of Medicine and Dentistry of New Jersey. The hospital is a Level 1 Trauma Center with an ethnically diverse patient population; only 17 percent of its patients receive Medicare benefits.

Project activities are centered in the hospital's Surgical Intensive Care Unit and extend into the Emergency Department and step-down unit. The UMDNJ project patient populations include those experiencing trauma, liver transplants and general and other surgery, although the families of these patients are also direct recipients of the palliative care interventions.

The project's Co-principal Investigators, Anne Mosenthal, M.D. and Pat Murphy, Ph.D. A.P.N., "are very excited about the unique possibilities of this grant." They believe that the collaboration between University Hospital and the New Jersey Medical School is distinctive because "patients in the Surgical Intensive Care Unit are often young and critically ill without warning, and this causes an enormous amount of stress on patients, families and staff." There is great uncertainty in the Surgical ICU about who will die, and familiar palliative care models do not fit the clinical realities of a Trauma/Surgical ICU (SICU).

Mosenthal and Murphy, along with their colleagues, are building their project on shared decision making, pain and symptom management and ongoing family bereavement support. A key component of the project is staff education, based in both the EPERC (End-of-Life/Palliative Education Resource Center) for physicians and ELNEC (End-of-Life Nursing Education Consortium) for nurses curriculums. A core team, in place and well-accepted, is introducing palliative care tools and practices into existing clinical structures and training selected nurses and physicians' assistants as 24-hour onsite resource palliative care "experts." The project is integrated into the structures and processes of the SICU, and does not function as an external consult service.

Project Goals are:

• Every patient admitted to the SICU will have:
  • Bereavement/psychosocial support for patients/families within 24 hours of admission to the SICU;
  • Interdisciplinary palliative care assessment within 24 hours of admission;
  • Family meeting with physician and nurse within 72 hours of admission to the SICU;
  • Comprehensive interdisciplinary palliative care plan on the medical record within 72 hours;
  • Update of palliative care plan for each patient every 72 hours or as condition necessitates; and
  • Implementation of structured palliative/end-of-life care pathway and standing orders for patients who are identified from the above processes to be imminently dying.
• Palliative care performance will be integrated into morbidity-and-mortality conferences (M & Ms) and peer reviews:
  • SICU mortality reviews;
  • Surgery M & Ms; and
  • Liver transplant morbidity reviews.
• Interdisciplinary Intervention Team that includes the project team (see below), palliative resource nurses and a pastoral care provider.

Tools:

Resources:

Related Resources:

Book Chapter:
Mosenthal, A., Price, D. & Murphy, P. "Interdisciplinary care" In Surgical Palliative Care, Dunn, G.P. & Johnson, A. (ed). Oxford, Oxford University Press, 2004

Articles:
Mosenthal, A. "Palliative Care in the Surgical ICU" Surgical Clinics of North America, 85 (2005): 303-313.

Mosenthal, A. & Murphy, P. Trauma care and palliative care: time to integrate the two? Journal of the American College of Surgeons. 197, 3, 509-516, September, 2003.

Lessons Learned:

Team Members:

Anne C. Mosenthal, M.D., FACS Principal Investigator
Chief of Surgical Critical Care
University of Medicine & Dentistry of New Jersey

Patricia Murphy, Ph.D., A.P.N., FAAN Principal Investigator
Advanced Practice Nurse, Ethics and Bereavement
University of Medicine & Dentistry of New Jersey
University Hospital G-345

Kris Barker, M.A.
Research Tech Specialist III
University of Medicine & Dentistry of New Jersey
University Hospital

Janet Harris Smith, M.S.
Bereavement/Family Support Counselor
University of Medicine & Dentistry of New Jersey
University Hospital

Susan McVicker, M.S.
Bereavement/Family Support Counselor
University of Medicine & Dentistry of New Jersey
University Hospital

Robin Preisler
Executive Director, Marketing and Media Relations
University of Medicine & Dentistry of New Jersey
University Hospital

Contact Information:

Anne Mosenthal, M.D., FACS, Principal Investigator
Associate Professor of Surgery
New Jersey School of Medicine
Surgery
85 South Orange Ave.
Newark, NJ 07103
Phone: 973.972.6398
Fax: 973.972.6803
mosentac@umdnj.edu

Pat Murphy, Ph.D., A.P.N., FAAN, Principal Investigator
Advanced Practice Nurse
Ethics and Bereavement
University Hospital G-345150 Bergen Street
Newark, NJ 07103
Phone: 973.972.7251
Fax: 973.972.7154
murphypa@umdnj.edu

Web sites:
www.umdnj.edu/homepage/

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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.