Background: Mortality rates within ICUs are high due to the obvious acuity of admitted patients, and a high level of palliative care (PC) interventions might be anticipated. Despite this what constitutes PC practice within ICU is not well understood. In a recent systematic scoping review, from the 7,625 abstracts screened related to PC in ICU- none originated in Ireland.  In addition, policies, and auditing activities related to PC in ICU were not evident across healthcare sites.  

Aims: 1. To measure routine PC key performance indicators (KPIs) and 2. to explore a contextual understanding of current PC practices and unmet needs.

Methods: A mixed method design was employed: a chart review of patents’ admissions (n=132) to a large urban academic hospital from the 1st November to the 31st of January 2022 was audited for KPIs that represent best practice of PC.  This audit was supplemented with interviews (n=3) and focus groups (n=11) with ICU clinicians.  Braun and Clark’s thematic framework was utilised to  analyse the interview data.  Site and institutional ethics were obtained. 

Findings: Low-performance measures were found on offering spiritual and social support by day three.  Low performance measures were noted on the holding of an interdisciplinary family meeting by day five.  The assessment of pain occurred 95% of the time.  Only 5% of the n=132 were referred to specialist PC (SPC)- indicating limited access to SPC.  Dialogue with ICU clinicians confirmed limited  access to SPC.  The needs reported included varying practices, misconceptions, lack of education/skills and the need for better collaboration.  

Conclusions:  Findings from this study re-enforced that PC in Irish ICUs are not in-line with policy.  These findings have informed the participatory approach to the development of an innovative and integrative intervention to optimise Irish ICU care that is contextually relevant and appropriate to improve quality of service.