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Contemporary Reviews in Critical Care Medicine |

Integration of Palliative Care in the Context of Rapid ResponseRapid Response Palliative Care: A Report From The Improving Palliative Care in the ICU Advisory Board

Judith E. Nelson, MD, JD, FCCP; Kusum S. Mathews, MD, MPH; David E. Weissman, MD; Karen J. Brasel, MD, MPH; Margaret Campbell, PhD, RN; J. Randall Curtis, MD, MPH; Jennifer A. Frontera, MD; Michelle Gabriel, MS, RN; Ross M. Hays, MD; Anne C. Mosenthal, MD; Colleen Mulkerin, MSW; Kathleen A. Puntillo, PhD, RN; Daniel E. Ray, MD, FCCP; Stefanie P. Weiss, MA; Rick Bassett, MSN, RN; Renee D. Boss, MD; Dana R. Lustbader, MD on behalf of The Improving Palliative Care in the ICU Project Advisory Board
Author and Funding Information

From the Icahn School of Medicine at Mount Sinai (Drs Nelson and Mathews and Ms Weiss), New York, NY; Medical College of Wisconsin (Drs Weissman and Brasel), Milwaukee, WI; Wayne State University (Dr Campbell), Detroit, MI; University of Washington School of Medicine (Drs Curtis and Hays), Seattle, WA; The Cleveland Clinic (Dr Frontera), Cleveland, OH; VA Palo Alto Health Care System (Ms Gabriel), Menlo Park, CA; Rutgers New Jersey Medical School (Dr Mosenthal), East Orange, NJ; Hartford Hospital (Ms Mulkerin), Hartford, CT; University of California, San Francisco (Dr Puntillo), San Francisco, CA; Lehigh Valley Health Network (Dr Ray), Allentown, PA; St. Luke’s Hospital (Mr Bassett), Boise, ID; Johns Hopkins University School of Medicine (Dr Boss), Baltimore, MD; and Hofstra North Shore-Long Island Jewish School of Medicine (Dr Lustbader), Hempstead, NY.

CORRESPONDENCE TO: Kusum S. Mathews, MD, MPH, Icahn School of Medicine, One Gustave L. Place, Box 1232, New York, NY 10029; e-mail: kusum.mathews@mssm.edu


FUNDING/SUPPORT: The IPAL-ICU Project is based at Icahn School of Medicine at Mount Sinai with support from the National Institute on Aging [K07 Academic Career Leadership Award AG034234 to Dr Nelson] and the Center to Advance Palliative Care. Dr Mathews’ effort was supported by the National Heart, Lung, and Blood Institute [Grant 1K12HL109005-01].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):560-569. doi:10.1378/chest.14-0993
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Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.


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