Early vs Usual Palliative Care Consultation in the Icu: Augmenting the Critical Care Physician to Decrease in-Hospital Mortality

Helgeson, Scott A; Burnside, Rebecca; Robinson, Maisha T.

doi:10.1016/j.chest.2019.08.803

Cited by 2 publications

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“…Despite the known benefits of an early palliative medicine consultation ( 2 ), it remains underused ( 6 ). Prompting the consultation based on known trigger criteria at the beginning of the day may be an efficient way to involve the palliative medicine team in the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Palliative medicine consultation in the ICU for high-risk, critically ill patients has a significant impact on change in code status, referral to hospice, ventilator days, rate of tracheostomy, emergency department visits, and ICU readmissions ( 1 ). Some studies have shown a further increase in beneficial outcomes if the consult is done earlier than 24 hours ( 2 ). This is especially helpful if certain triggers are identified to prompt a palliative care consultation ( 3 ).…”

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Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

Babar

Eilenfeld

Alqaisi

et al. 2021

Critical Care Explorations

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OBJECTIVES: Early palliative medicine consult in the ICU can significantly improve outcomes in high-risk patients. We describe a pilot study of including a recommendation for palliative medicine consult in the ICU morning huddle. DESIGN: A prospective, observational, quality improvement study. PATIENTS AND SETTING: Adult patients (age above 18 yr) admitted with cardiac arrest, stage IV cancer, admission from a long-term acute care facility, and circulatory shock on mechanical ventilation to the medical ICU. INTERVENTIONS: We aim to assess the effect of an early palliative medicine consultation in selected high-risk patients on change in code status, referral to hospice, tracheostomy, and or percutaneous gastrostomy tube placement. MEASUREMENTS AND MAIN RESULTS: There were 83 patients who triggered an early palliative medicine consult. Palliative medicine consultation occurred in 44 patients (53%); 23 patients (28%) had a palliative medicine consult within the first 48 hours, 21 (25%) had a palliative medicine consult afterwards. There was a significantly higher number of patients who de-escalated their code status in the palliative medicine consult group compared with the no palliative medicine consult group (63.6% vs 7.7%); however, the number was higher in the late palliative medicine consult group (71.4% vs 56.5%). There were more patients referred to hospice in the palliative medicine consult group. No difference in length of stay was observed. CONCLUSIONS: Early palliative medicine consultation in the daily ICU morning huddle is achievable, can produce a palliative medicine consultation in most cases, and results in a significant change in code status toward less aggressive measures.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

Babar

Eilenfeld

Alqaisi

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

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Palliative Care Consultation and Cost of Stay in out of Hospital Cardiac Arrest

Goertz

DeJoy

Torres

et al. 2022

Am J Hosp Palliat Care

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Background: Cardiac arrest is a critical condition with high clinical, economic, and emotional burden. The role of palliative medicine in the management of critical patients has grown and, in some areas, has shown reduced cost of stay. This study set out to examine the association of palliative care involvement in out of hospital post cardiac arrest patients and cost of stay. Methods: This is a single center retrospective analysis of all patients ≥18 years of age who were admitted at our institution from March 2018 to June 2019 with out of hospital cardiac arrest. Patients who immediately died in the emergency department were excluded. Patients were then classified according to whether palliative care was consulted. Total charges were obtained from the billing records and compared between those with palliative care compared to those without using Mann–Whitney U test. Results: A final sample of 98 patients that were included in the analysis. The mean age was 61.2 ± 17.3, 46% were female, and 61% were African American. Palliative care consultation was present in 27 (28%) of patients. There were no significant differences among age, gender, ethnicity, BMI, SOFA scores, and common comorbidities among those who did and did not have palliative care consultation. While there was a significantly longer ICU length of stay and mechanical ventilation days among patients with palliative care involvement P < .0001, the charges among patients with palliative care involvement were not statistically significantly different $59,245 ($3744-148,492) (median IQR) compared to those without palliative care $79,521 ($6540-157,952) P = .762. Conclusion: Length of stay increased with palliative care consultation which may relate more to the inherent clinical scenario. Cost of stay was not statistically significantly different.

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Early vs Usual Palliative Care Consultation in the Icu: Augmenting the Critical Care Physician to Decrease in-Hospital Mortality

Cited by 2 publications

References 0 publications

Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

Palliative Care Consultation and Cost of Stay in out of Hospital Cardiac Arrest

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