Early Palliative Care Consultation in the Medical Intensive Care Unit—A Clustered Randomized Crossover Trial (TH371B)

Ma, Jessica; Chi, Stephen; Buettner, Benjamin; Pollard, Katherine; Muir, Monica; Kolekar, Charu; Kollef, Marin H.; Dans, Maria

doi:10.1016/j.jpainsymman.2018.12.095

Cited by 7 publications

(5 citation statements)

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“…32,33 A recent randomized controlled trial of early palliative care involvement in critically ill ICU patients resulted in increased use of hospice services, and a decrease in burdensome interventions at the end-of-life such as tracheostomies, without an increase in mortality compared to patients receiving usual care. 34 The patients and families in our cohort received frequent psychosocial support and counseling from the interdisciplinary palliative care team. Additionally, early involvement of palliative care, during a time when the patient is critically ill but stabilized on ECMO, allowed the requisite time for rapport building with families and for determining surrogate decision-maker hierarchy.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Rao

Zaaqoq

Kang

et al. 2021

Am J Hosp Palliat Care

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Background: Critically ill patients with COVID-19 infection on extracorporeal membrane oxygenation (ECMO) face high morbidity and mortality. Palliative care consultation may benefit these patients and their families. Prior to the pandemic, our institution implemented a policy of automatic palliative care consultation for all patients on ECMO due to the high mortality, medical complexity, and psychosocial distress associated with these cases. Objectives: The main objective was to describe the role of the palliative care team for patients on ECMO for COVID-19 infection. The secondary objective was to describe the clinical outcomes for this cohort. Design: Case series. Settings/Subjects: All patients age 18 or older infected by the novel coronavirus who required cannulation on ECMO from March through July of 2020, at an urban, academic medical center in the United States. Inter-disciplinary palliative care consultation occurred for all patients. Results: Twenty-three patients (median age 43 years [range 28-64], mean body mass index 34.9 kg/m2 [SD 9.2], 65% Hispanic ethnicity) were cannulated on ECMO. Eleven patients died during the hospitalization (48%). Patients older than 50 years of age demonstrated a trend toward increased odds of death compared to those younger than 50 years of age (OR 9.1, P = 0.07). Patients received an average of 6.8 (SD 3.7) palliative clinical encounters across all disciplines. The actions provided by the palliative care team included psychosocial support and counseling, determination of surrogate decision maker (for 100% of patients), pain management (83%), and non-pain symptom management (83%). Conclusions: Here, we present one of the first studies describing the patient characteristics, outcomes, and palliative care actions for critically ill patients with COVID-19 on ECMO. Almost half of the patients in this cohort died during their hospitalization. Given the high morbidity and mortality of this condition, we recommend involvement of palliative care for patients/families with COVID-19 infection who are on ECMO. The impact of palliative care on patient and family outcomes, such as symptom control, satisfaction with communication, rates of anxiety, and grief experience merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Rao

Zaaqoq

Kang

et al. 2021

Am J Hosp Palliat Care

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“…22,23 Rate of palliative medicine consults potentially can be improved in the future with use of triggered palliative medicine consults which are associated with more transfers to hospice, decreased rates of tracheostomy placement, fewer days on mechanical ventilation, and no change in 30 day mortality. 24…”

Section: Discussionmentioning

confidence: 99%

Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic

Piscitello

Fukushima

Saulitis

et al. 2020

Am J Hosp Palliat Care

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Purpose: Visitor restrictions during the COVID-19 pandemic limit in-person family meetings for hospitalized patients. We aimed to evaluate the quantity of family meetings by telephone, video and in-person during the COVID-19 pandemic by manual chart review. Secondary outcomes included rate of change in patient goals of care between video and in-person meetings, the timing of family meetings, and variability in meetings by race and ethnicity. Methods: A retrospective cohort study evaluated patients admitted to the intensive care unit at an urban academic hospital between March and June 2020. Patients lacking decision-making capacity and receiving a referral for a video meeting were included in this study. Results: Most patients meeting inclusion criteria (N = 61/481, 13%) had COVID-19 pneumonia (n = 57/61, 93%). A total of 650 documented family meetings occurred. Few occurred in-person (n = 70/650, 11%) or discussed goals of care (n = 233/650, 36%). For meetings discussing goals of care, changes in patient goals of care occurred more often for in-person meetings rather than by video (36% vs. 11%, p = 0.0006). The average time to the first goals of care family meeting was 11.4 days from admission. More documented telephone meetings per admission were observed for White (10.5, SD 9.5) and Black/African-American (7.1, SD 6.6) patients compared to Hispanic or Latino patients (4.9, SD 4.9) (p = 0.02). Conclusions: During this period of strict visitor restrictions, few family meetings occurred in-person. Statistically significant fewer changes in patient goals of care occurred following video meetings compared to in-person meetings, providing support limiting in-person meetings may affect patient care.

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“…Verificou-se que quanto mais precoce o encaminhamento, maior a redução de custos (3 artigos) 14,15,19 ; Categoria 4: Nesta categoria está um estudo em que não se demonstrou relação entre redução de custos e intervenções de equipes consultoras de Cuidados Paliativos realizadas no ambiente hospitalar (1 artigo) 20 .…”

Section: Resultados E Discussõesunclassified

“…Os oito estudos foram realizados em países desenvolvidos, quase todos nos Estados Unidos (EUA). Apenas um dos estudos foi intervencionista 15 . Os resultados desse estudo apontam que, o grupo que recebeu o acompanhamento com equipe consultora de Cuidados Paliativos, teve maior número de desospitalizações, pacientes com menos dias em ventilação mecânica, menos traqueostomias realizadas, e menos visitas e/ou reinternações em serviços de emergência pós-alta.…”

Section: Resultados E Discussõesunclassified

Impacto econômico da atuação de equipes consultoras de Cuidados Paliativos inseridas em hospital

Santos

Fonseca²

2021

HRJ

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Internações de pacientes crônicos são, em geral, prolongadas. Frequentemente empregam-se medidas inadequadas que, além de prolongar sofrimento, representam consumo de substanciais recursos de saúde. Nesse contexto, a atuação de equipes consultoras de Cuidados Paliativos (CP) pode representar incremento na qualidade do cuidado e redução dos custos. O objetivo deste estudo é apresentar os resultados de uma revisão bibliográfica sobre o impacto econômico da atuação de equipes consultoras de CP inseridas em hospitais durante o período de 2015 a 2020. Trata-se de uma revisão sistemática de literatura nos bancos de dados LILACS, SCOPUS (Elsevier), PubMed, SciELO e MEDLINE. Oito trabalhos atenderam aos critérios de inclusão. Há evidências de que intervenções das equipes consultoras de CP favorecem a redução de custos hospitalares, na medida em que contribuem para menores taxas de readmissão hospitalar, menor tempo médio de permanência, menor número de procedimentos diagnósticos e terapêuticos e menor número de admissões em UTI. Há vantagem econômica da abordagem de equipes consultoras de CP. Dessa forma, as evidências podem auxiliar na tomada de decisão de gestores de saúde quanto à organização de serviços e investimento em equipes especializadas em CP.

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Early Palliative Care Consultation in the Medical Intensive Care Unit—A Clustered Randomized Crossover Trial (TH371B)

Abstract: by pediatric death is sparse. Existing literature raises concerns that certain services might be unavailable to some populations. More research is needed to understand why bereavement support services are not uniformly available and to develop programs for underserved populations.

Cited by 7 publications

References 0 publications

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection

Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic

Impacto econômico da atuação de equipes consultoras de Cuidados Paliativos inseridas em hospital

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