Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review

Yuta Tanaka; Kento Masukawa; Hideaki Sakuramoto; Akane Kato; Yuichiro Ishigami; Junko Tatsuno; Kaori Ito; Yoshiyuki Kizawa; Mitsunori Miyashita

doi:10.1186/s40560-023-00713-z

Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review

J Intensive Care. 2024 Jan 9;12(1):1. doi: 10.1186/s40560-023-00713-z.

Authors

Yuta Tanaka¹, Kento Masukawa², Hideaki Sakuramoto³, Akane Kato⁴, Yuichiro Ishigami⁵, Junko Tatsuno⁶, Kaori Ito⁷, Yoshiyuki Kizawa⁸, Mitsunori Miyashita²

Affiliations

¹ Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. tana@med.tohoku.ac.jp.
² Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
³ Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan.
⁴ Department of Adult and Geriatric Nursing, School of Health Science, Shinshu University, Matsumoto, Nagano, Japan.
⁵ Department of Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan.
⁶ Nursing Department, Kokura Memorial Hospital, Fukuoka, Japan.
⁷ Department of Surgery, Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan.
⁸ Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.

Abstract

Background: Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review and modified Delphi method, and test their feasibility by reviewing electronic medical record (EMR) data.

Methods: The current study was performed in two phases: the development of QIs using the modified Delphi method, and pilot-testing the quality of palliative care in ICUs based on EMR review. The pilot test included 262 patients admitted to the general or emergency ICU at a university hospital from January 1, 2019, to June 30, 2019.

Results: A 28-item QI set for palliative care in ICUs was developed based on the consensus of 16 experts. The Delphi process resulted in low measurability ratings for two items: "Assessment of the patient's psychological distress" and "Assessment of the patient's spiritual and cultural practices." However, these items were determined to be important for quality care from the perspective of holistic assessment of distress and were adopted in the final version of the QI set. While the pilot test results indicated the feasibility of the developed QIs, they suggested that the frequency of care performance varied, and certain aspects of palliative care in ICUs needed to be improved, namely (1) regular pain assessment, (2) identification of the patient's advance directive and advance care planning for treatment, (3) conducting an interdisciplinary family conference on palliative care, and (4) assessment of psychological distress of family members.

Conclusions: The QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs.

Keywords: Critical care; Intensive care; Intensive care units; Palliative care; Quality indicator.