The Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, long at the forefront of innovation, has changed the way seriously ill patients are cared for in intensive care units (ICUs).
In 2020, Mount Sinai began embedding a dedicated palliative care team in the medical intensive care unit (MICU) at The Mount Sinai Hospital. Introducing palliative care earlier in the hospital admissions process, rather than waiting for ICU doctors to request a consult, has led to improved outcomes and quality of care for seriously ill patients and their caregivers.
In 2023, Mount Sinai appointed Ankita Mehta, MD, Associate Professor, Geriatrics and Palliative Medicine at Icahn Mount Sinai, to the newly created position of Director of Palliative Care for Mount Sinai Health System Intensive Care Units. Dr. Mehta oversees the integration of palliative care in all ICUs across all the hospitals in the Mount Sinai Health System.
In this novel approach, dedicated palliative care teams consisting of a specialist physician, registered nurse, social worker, and chaplain are embedded in the ICUs to identify which seriously ill patients could benefit from an added layer of support. The palliative care teams offer pain and symptom management and work with patients and families to identify their values and goals of care. By working in close collaboration with interdisciplinary ICU teams, the care delivered is better aligned with the patient’s wishes. Positive patient outcomes increase with such thorough care coordination and advance care planning, which has been linked to increased patient satisfaction, decreased costs, and decreased treatments that are perceived as burdensome by patients and their families.
More than a decade ago, Mount Sinai created the Institute for Critical Care Medicine (ICCM), which united all Health System critical care programs—medicine, surgery, cardiac, neurology, neurosurgery—under one umbrella to enhance quality, coordinated services, and to improve communication across all critical care units. It became evident that palliative care needed to be a core component of that initiative. This led to the expansion of the innovative work at The Mount Sinai Hospital throughout the various critical care units and, eventually, throughout the Health System.
“The role of palliative care teams in critical care is to provide an added layer of support,” says R. Sean Morrison, MD, Ellen and Howard C. Katz Chair of the Brookdale Department. “In addition to focusing on patients’ symptoms to make them as comfortable as possible, they facilitate communication among the many specialists and patients and family members and play an important role in addressing the emotional, spiritual, and psychological needs of both patients and their families, and in reducing their anxiety and distress. The goal is to have one quality standard of care for critically ill patients and their families within the entire Mount Sinai system.”
According to a paper published in the Journal of Pain and Symptom Management, Mount Sinai’s Dr. Mehta and her colleagues found that this approach has led to more than a three-fold increase in the number of patients who received specialty-level palliative care in the MICU, giving the embedded palliative care team the opportunity to address unmet needs sooner. In addition, data show these patients are less likely to die in the ICU and more likely to be discharged from the hospital to home or a rehab facility.
“We have seen the benefits of providing palliative care in ICUs, and Mount Sinai is pioneering this direct leadership role and investing in it as an institution,” says Dr. Mehta. “We have already made a big impact and, as we continue to think about this system-wide, we are hopeful we can continue to improve quality outcomes and extend our reach of palliative care to all critically ill patients.”