Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Sayed K. Ali

Second Supervisor/Advisor

Dr. Jasmit Shah

Third Supervisor/Advisor

Dr. John Weru


Internal Medicine (East Africa)


Background: Palliative care triggers have been used in the Intensive Care Unit (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 have not been previously studied in sub-Saharan Africa.

Objectives: The primary objective of this study was to estimate the prevalence of ICU admissions who meet the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality, and time to formal change of goals of care orders.

Methods: A prospective observational cohort study was conducted within the ICU at The Aga Khan University Hospital, Nairobi between December 2019 and August 2020. All adults age ≥ 18 years admitted to the ICU in that period at Aga Khan University Hospital were recruited. Data including initiation of a palliative care consult, length of ICU stay, mortality, and time to change of goals of care orders were collected.

Results: During the study period, 72 of 159 (45.9%) patients met at least one criterion for palliative care referral. 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 of care 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 regard to length of ICU stay, mortality, and time to change of goals of care orders.

Conclusion: A trigger-based model, geared to the needs of the specific ICU, maybe one way of improving integration of palliative care into the ICU.