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BMJ Open Qual. 2019 Sep 6;8(3):e000513. doi: 10.1136/bmjoq-2018-000513. eCollection 2019.

Implementing primary palliative care best practices in critical care with the Care and Communication Bundle.

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University of Florida College of Nursing, Gainesville, Florida, USA.
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.



Clinician-family communication is a central component of medical decision-making in the intensive care unit (ICU) and the quality of this communication has a direct impact on decisions made regarding care for patients who are critically ill.


The purpose of the project was to emphasise the need for quality improvement in the medical ICU at the University of Florida Health Hospital in regard to communication between the patients, families and providers.


Interventions included development of a more systemic approach to primary palliative care by using the nationally recognised and published Care and Communication Bundle tool. The Bundle is a standardised clinical pathway of palliative care best practices.


During the project period, staff satisfaction/engagement increased from tier 3 to tier 1 level, the medical ICU length of stay decreased from 4.97 days in fiscal year (FY) 2016 to 4.22 days in FY2017. Moreover, the number of patients discharged directly to hospice increased from 21 in FY2016 to 42 in FY2017, representing a 100% increase. Additionally, palliative care consults decreased in the medical ICU (FY2016=108, FY2017=82), as a result of an increase in daily primary palliative care interventions. The findings demonstrate an improvement in outcome measures during the project.


Care and Communication Bundle; ICU; advance directive; critical care; family meeting; palliative care; provider communication

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