{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:07:43Z","timestamp":1780060063519,"version":"3.54.0"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Prior to the COVID-19 pandemic, the mortality of patients admitted to intensive care units (ICUs) in the UK reached 20%. Studies show up to 40% of these patients may have been eligible for palliative care (PC) referral on admission to the ICU. The involvement of PC teams improves the quality of care delivered and improves patient and family satisfaction. Several trigger tools have been developed to identify ICU patients most likely to benefit from palliative care; however, no consensus exists regarding the most effective tool. Methods: We conducted a retrospective study to identify the number of PC referrals, prior to death in a general ICU setting over a 7-month period in 2019. For patients not referred to PC, three separate \u201ctrigger tools\u201d, previously described in the literature, were retrospectively applied to explore the potential impact each tool may potentially have had on PC referral rates. Results: We identified 121 ICU deaths, of which 28 patients (23%) were referred to PC during their admission to the ICU. After retrospective application of the trigger tools to those who were not referred, 75% (n = 70) of patients triggered at least one criterion using the \u201cZalenski et al.\u201d tool and 71% (n = 66) of patients were eligible for referral had the \u201cHua et al.\u201d tool had been used. Overall, 82% (n = 36) of cancer patients met at least one criterion for referral with the Royal Marsden tool. Conclusions: Our study supports a finding of poor utilisation of PC services in an ICU patient population. The use of trigger tools can be used to significantly increase the number of appropriate PC referrals in an intensive care setting and may be useful in predicting those who may die. The benefit of PC intervention is aimed at providing holistic support to both patient and family and is associated with better patient and family experience towards the end of life.<\/jats:p>","DOI":"10.3390\/jcm14124275","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T09:51:22Z","timestamp":1750067482000},"page":"4275","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Utilising Palliative Care Expertise in Critically Ill Patients: Opportunities to Improve Outcomes and Experiences"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1235-3312","authenticated-orcid":false,"given":"Tajveer","family":"Sara","sequence":"first","affiliation":[{"name":"Department of Critical Care, University College London Hospital, London NW1 2BU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University College London Hospital, London NW1 2BU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.12688\/wellcomeopenres.15931.2","article-title":"Healthcare resource utilisation and mortality outcomes in international migrants to the UK: Analysis protocol for a linked population-based cohort study using Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and the Office for National Statistics (ONS)","volume":"5","author":"Pathak","year":"2021","journal-title":"Wellcome Open Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gomes, B., Calanzani, N., Koffman, J., and Higginson, I.J. (2015). Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Med., 13.","DOI":"10.1186\/s12916-015-0466-5"},{"key":"ref_3","unstructured":"Cosgrove, J., Baruah, R., Bassford, C., Blackwood, D., Pattison, N., and White, C. (2019). Care at the End of Life: A Guide to Best Practice, Discussions and Decision-Making in and Around Critical Care, The Faculty of Intensive Care Medicine."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1136\/bmjspcare-2014-000770","article-title":"Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)","volume":"5","author":"Hillman","year":"2015","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Lund, S., Richardson, A., and May, C. (2015). Barriers to advance care planning at the end of life: An explanatory systematic review of implementation studies. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116629"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.7861\/fhj.9-2-s51","article-title":"Ageing and frailty in the UK","volume":"9","author":"Acharya","year":"2022","journal-title":"Future Healthc. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13054-021-03465-0","article-title":"Death in hospital following ICU discharge: Insights from the LUNG SAFE study","volume":"25","author":"Madotto","year":"2021","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.jpainsymman.2020.04.027","article-title":"Redefining palliative care\u2014A new consensus-based definition","volume":"60","author":"Radbruch","year":"2020","journal-title":"J. Pain Symptom Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"a943","DOI":"10.1136\/bmj.a943","article-title":"A strategy for end of life care in the UK","volume":"337","author":"Riley","year":"2008","journal-title":"BMJ"},{"key":"ref_10","unstructured":"National Palliative and End of Life Care Partnership (2021). Ambitions for Palliative and End of Life Care: A National Framework for Local Action 2021\u20132026, NHS England."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"c4860","DOI":"10.1136\/bmj.c4860","article-title":"Dying matters: Let\u2019s talk about it","volume":"341","author":"Seymour","year":"2010","journal-title":"BMJ"},{"key":"ref_12","first-page":"348","article-title":"The role of palliative care at the end of life","volume":"11","author":"Rome","year":"2011","journal-title":"Ochsner J."},{"key":"ref_13","unstructured":"Intensive Care National Audit and Research Centre (2022, July 01). Key Statistics from the Case Mix Programme\u2014Adult, General Critical Care Units. Available online: https:\/\/www.icnarc.org\/Our-Audit\/Audits\/Cmp\/Reports\/Summary-Statistics."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/1751143720928898","article-title":"Bereavement in critical care: A narrative review and practice exploration of current provision of support services and future challenges","volume":"22","author":"Pattison","year":"2021","journal-title":"J. Intensive Care Soc."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mercadante, S., Gregoretti, C., and Cortegiani, A. (2018). Palliative care in intensive care units: Why, where, what, who, when, how. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0574-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1164\/rccm.201307-1229OC","article-title":"Estimates of the need for palliative care consultation across United States intensive care units using a trigger-based model","volume":"189","author":"Hua","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1136\/bmjspcare-2013-000570","article-title":"Evaluation of screening criteria for palliative care consultation in the MICU: A multihospital analysis","volume":"4","author":"Zalenski","year":"2014","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1007\/s00520-021-06542-w","article-title":"Integrated palliative care: Triggers for referral to palliative care in ICU patients","volume":"30","author":"Nadkarni","year":"2022","journal-title":"Support. Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4037\/ccn2015357","article-title":"Overcoming barriers to palliative care consultation","volume":"35","author":"Perrin","year":"2015","journal-title":"Crit. Care Nurse"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S324","DOI":"10.1097\/01.CCM.0000237249.39179.B1","article-title":"Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit","volume":"34","author":"Nelson","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2144093","DOI":"10.1001\/jamanetworkopen.2021.44093","article-title":"Assessment of clinical palliative care trigger status vs actual needs among critically ill patients and their family members","volume":"5","author":"Cox","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1007\/s00134-014-3471-9","article-title":"Survival in solid cancer patients following intensive care unit admission","volume":"40","author":"Puxty","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e371","DOI":"10.3399\/bjgp11X578052","article-title":"Recognising patients who will die in the near future: A nationwide study via the Dutch Sentinel Network of GPs","volume":"61","author":"Abarshi","year":"2011","journal-title":"Br. J. Gen. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jpainsymman.2020.02.001","article-title":"Triggered palliative care consults: A systematic review of interventions for hospitalized and emergency department patients","volume":"60","author":"Kistler","year":"2020","journal-title":"J. Pain Symptom Manag."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4275\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:52:49Z","timestamp":1760032369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124275"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124275","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]}}}