Assessment of Palliative Care Needs in a Kenyan Intensive Care Unit Using a Trigger-Based Model.

CONTEXT: Palliative care triggers have been used in the ICU setting, usually in high income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU has not been previously studied in sub-Saharan Africa.

OBJECTIVES: Our objectives were to determine the prevalence of ICU admissions who met at least one palliative care trigger and whether a palliative care consult influenced the length of ICU stay and time to change of goals order.

METHODS: We conducted a prospective observational cohort study within our ICU at The Aga Khan University Hospital, Nairobi between December 2019 and August 2020. Data including initiation of a palliative care consult, length of ICU stay, mortality and time to change of goals order was collected.

RESULTS: During our study period, 72 of 159 (45.9%) patients met at least one palliative care trigger point. Of the patients who met the palliative care triggers, only 29.2% received a palliative care consult. Patients who received palliative care consults had higher rates of change of goals orders signed (52.3%) versus those who did not (P=0.009). There was no statistically significant difference between the consult and non-consult groups in regards to length of ICU stay, time to change of goals order and mortality.

CONCLUSION: A trigger-based model, geared to the needs of the specific ICU, may be one way of improving integration of palliative care into the ICU, especially in sub-Saharan Africa.