Author ORCID Identifier

https://orcid.org/0009-0003-4257-3528

Semester

Fall

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Emily Barnes

Committee Member

Cara Hawkins

Committee Member

Daniel Gordon

Committee Member

Mohammed Quazi

Abstract

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) and completed daily by nurses during morning assessments. Positive screens were reviewed during rounds to guide consultation decisions. Implementation was supported by nurse and provider champions and guided by iterative Plan-Do-Study-Act cycles.

Methods: Measures included screening completion (process), time from admission to consult order (outcome), nurse moral distress (outcome), and MICU length of stay, disposition, and mortality (balancing). Data were analyzed descriptively and with inferential testing.

Results: Screening completion declined (Cycle 1: 34%, Cycle 2: 21%, Cycle 3: 15%). While mean times remained above the 48-hour benchmark, median times met or exceeded the goal across all cycles, improving from 112 hours at baseline to 30, 42, and 48 hours in Cycles 1–3. Nurse moral distress showed modest improvement. MICU length of stay decreased across cycles, while mortality remained consistent.

Conclusions: A nurse-driven screening tool reduced time to palliative care consultation and supported staff experience but faced adoption challenges. Sustainability requires EHR integration at admission, stronger interprofessional engagement, and system-level support.

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