IMPACT-ICU Project Summary
April 2014
What is the IMPACT-ICU Project?
 The IMPACT-ICU project is an quality improvement program designed to increase integration of palliative
care into the ICU by training and supporting ICU bedside nurses to identify and address needs in 3 domains:
1) patient symptom management, 2) family support, and 3) multidisciplinary communication about prognosis
and goals of care.
Why was the IMPACT-ICU Project Developed?
 The IMPACT-ICU project was developed by a multidisciplinary and multi-specialty team at the University of
California, San Francisco Medical Center, in response to requests from critical care nurses for training in
communication and increased support from the palliative care consult team in the ICU
 When integrated into the ICU, palliative care can
improve outcomes in all domains of the triple
aim: patient and family health, experience of
care, and resource utilization (Figure).
Successful and sustained integration of palliative
care into the ICU requires involvement of nurses,
patients’ closest bedside provider.
 In a system-wide survey of 597 critical care
nurses at the 5 University of California medical
centers, lack of training was the most frequently
cited barrier to nurses’ involvement in these
discussions of prognosis, goals of care, and
palliative care with families and other clinicians.
What are the IMPACT-ICU Project Components?
 The IMPACT-ICU project has two main components: 1) a workshop to train nurses to facilitate
communication about prognosis, goals of care and palliative care among families and physicians, and 2)
rounding in the ICUs by advance practice nurses to support bedside nurses as they screen and address
palliative care needs for their patients.
 Communicaiton workshop is 8-hours long, and uses learner-centered methods and role-play to practice
core communication skills in palliative care. Role-plays help nurses practice addressing patient needs
through conversations with families, physicians, and in family meetings to mimic their practice (Figure and
Table). A reflection session teaches practices to address nurses’ distress & burnout.
Wendy Anderson MD MS, Wendy.Anderson@ucsf.edu
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In the rounding component of the project, palliative and
critical care advance practice nurses and educators
round in target ICUs at each center. These nurse leaders
support bedside nurses to identify palliative care needs,
and work with ICU clinicians to address identified needs.
Bedside nurses are trained to screen patients for
uncontrolled symptoms, family distress, and
communication needs.
Nurse leaders provide direct access to specialty palliative
nursing, to help bedside nurses troubleshoot challenges.
Palliative care consult services are involved when the
ICU clinicians require assistance with complicated cases.
ICU &
Medical
Teams
Palliative
Care Consult
Service
ICU
Bedside
Nurse
Advanced
Practice
Palliative
Care Nurse
Social
Work
Spiritual
Care Service
Where has the IMPACT-ICU Project Been Implemented?
 After being piloted at the University of California, San Francisco Medical Center, the IMPACT-ICU project
was disseminated to all of the University of California (UC) Medical Centers: UC Irvine, UC San Diego, UC
Los Angeles, and UC Davis.
 This dissemination was made possible by generous support from the UC Office of the President Center for
Health Quality and Innovation Quality Enterprise Risk Management (CHQIQERM) program, a joint venture of
the University of California Center for Health Quality and Innovation and Office of Risk Services.
How has the IMPACT-ICU Project Been Received in the University of California System?
 The project has been very well received in the UC system. It has enjoyed broad support from the campus
Chief Nursing, Medical, and Risk Officers, all of whose approval was required to implement the project.

250 nurses have completed the communication workshop. Evaluations show that after the workshop, nurses
feel that they have a higher level of skill to engage in discussions with clinicians and families about prognosis,
goals of care, and palliative care, compared to before completing the workshop (Figure).
Figure: Workshop Evaluations. Participants rated their skill to engage in palliative care communication tasks before and after the
workshop. Response options were: “Excellent”, “Very Good”, “Good”, “Fair”, “Poor”; the chart shows the percentage of nurses
rating their skill as “Excellent” or “Very Good”. All differences before vs. after workshop are significant at p<0.001.
Use self-care practices to prevent
burnout and compassion fatigue
26%
Communicate the value of a palliative
care consultation to a physician
27%
71%
69%
Elicit a family’s understanding
of a patient’s goals of care
34%
71%
Before Workshop
Provide families with emotional
support during family meetings
37%
Ensure that a family member understands
information presented in a family meeting
37%
After Workshop
67%
75%
Identify a family’s need for information
about a patient’s illness and treatments
48%
78%
% of nurses rating their skill as "Excellent" or "Very Good"

Program evaluation is ongoing. Key processes and outcomes of care include support provided to nurses in
the target ICUs, nurses’ confidence in communication, frequency of clinician-family discussions and
documentation in the medical record, family satisfaction, and utilization including length of stay and costs.
Is Training Available to Implement the IMPACT-ICU Project in Other Hospitals and Health Systems?
 Yes! In the process of implementing the program the UC campuses, we have developed a faculty
development program that could be used to disseminate the program to other hospitals and systems.
IMPACT-ICU Project Summary April 2014, Page 2
Wendy Anderson MD MS, Wendy.Anderson@ucsf.edu