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Implementing primary palliative care best practices in critical care with the Care and Communication Bundle
  1. Cristina Vuong1,
  2. Sheri Kittelson2,
  3. Lindsay McCullough2,
  4. Yao Yingwei1,
  5. Tonja Hartjes1
  1. 1University of Florida College of Nursing, Gainesville, Florida, USA
  2. 2Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Cristina Vuong; cristinavuong{at}


Background 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.

Aim 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.

Method 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.

Results 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
  • palliative care
  • ICU
  • family meeting
  • provider communication
  • critical care
  • advance directive

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  • Contributors CV planned and conducted the study as well as drafting of the manuscript. SK designed the study and made contributions to the drafting and revision of manuscript. LM contributed to conduction and acquisition of data as well as revision of the manuscript. YY contributed to analysis and interpretation of data. TH made substantial contributions to the design of the study as well as drafting, revision of manuscript and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board (IRB) approval was granted by the University of Florida (IRB201701323).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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