Impact of a Palliative Care Program on Tracheostomy Utilization in a Community Hospital

Pan, Cynthia X.; Gutiérrez, Cristina; Maw, Min; Kansler, Amanda L.; Gross, Liam; He, Jie; Kanta, Romana; Paul, Subroto

doi:10.1089/jpm.2015.0172

Cited by 7 publications

(2 citation statements)

References 10 publications

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“…Additionally, several studies have shown that factors such as diagnosis, tracheostomy, home ventilator, and nutritional status can influence the discharge of PC patients to their homes. [20][21][22] In our study, it was found that cancer patients had a shorter hospital stay compared to other patient groups. Patients who underwent PEG, tracheostomy, and PU, and required home ventilator support, as well as those who could not be mobilized, had a significantly longer hospital stay compared to patients who could be mobilized and fed orally (P<0.001).…”

Section: Discussionsupporting

confidence: 45%

Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study

Parpucu,

Kahveci,

Döğer

et al. 2024

Anatolian Curr Med J / ACMJ / acmj

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Aims: The aim of this study was to establish the clinical characteristics and their impact on the length of stay (LOS) of patients discharged from a palliative care center (PCC) to home care (HC). Methods: Our cross-sectional study retrospectively analysed 314 patients who were discharged from PCC to HC between 1 January 2015 and 30 September 2018. The patients were divided into two groups based on their LOS in the PCC. Prolonged hospitalisation was defined as hospitalisation for more than 30 days. Clinical characteristics associated with prolonged hospitalization were analyzed. Results: The study included 314 patients, with 129 (41.08%) female and 185 (58.92%) male. The mean age was 68.41±18.91 years and the LOS in PCC was 36.27±40.34 days. Of the patients, 186 were hospitalized for 30 days or less, while 128 were hospitalized for more than 30 days. The most frequent diagnosis was cerebrovascular event (CVE) (37.57%). The most common accompanying chronic systemic diseases were hypertension (20.70%), followed by diabetes mellitus and heart failure (9.87%; 6.68%, respectively). Out of the total number of patients, 9.87% (n=31) were mobilized. Among them, 55.09% (n=173) were able to receive oral nutrition, 42.03% (n=132) had percutaneous endoscopic gastrostomy (PEG), 23.88% (n=75) had pressure ulcer (PU), and 27.07% (n=85) had tracheostomy. Additionally, 6.68% (n=24) of the patients were receiving respiratory support with a home ventilator. It was observed that the LOS of patients who were mobile, able to feed orally, and diagnosed with cancer was shorter. The presence of CVE (p=0.001), head trauma (p=0.013), hypoxic brain diagnosis (p=0.001), PEG (p

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Section: Discussionsupporting

confidence: 45%

Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study

Parpucu,

Kahveci,

Döğer

et al. 2024

Anatolian Curr Med J / ACMJ / acmj

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“… 17 It is reasonable to think, however, that virtually all patients will find benefit from palliative care involvement at these key pivot points in care. 18 19 …”

Section: Discussionmentioning

confidence: 99%

Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care

Colbert,

Streblow,

Sherry

et al. 2024

Trauma Surg Acute Care Open

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IntroductionAcute care surgeons are frequently consulted for tracheostomy placement in the intensive care unit (ICU). Tracheostomy may facilitate ventilator weaning and improve physical comfort. Short-term outcomes after tracheostomy are not well studied. We hypothesize that a high proportion of ICU patients who underwent tracheostomy died prior to discharge. These data will help guide clinical decision-making at a key pivot point in care.MethodsWe identified 177 mixed ICU patients who received a tracheostomy for respiratory failure between January 2013 and December 2018. We excluded patients with trauma. Patient information was collected and comparisons made with univariable and multivariable statistics.ResultsOf the 177 patients who underwent a tracheostomy for respiratory failure, 45% were women, median age was 63 (51–71) years. Of this group 18% died prior to discharge, 63% were discharged to a care facility and only 16% discharged home. Compared with survivors, patients with tracheostomies who died during their admission were older, age 69 (64–76) versus 61 (49–71) years (p<0.01) on univariable analysis. In this model, no single comorbid condition or length of stay (LOS) variable was predictive of death before discharge. A multivariable model controlling for covariation similarly identified age, as well as a longer ICU LOS of 34 (20–49) versus 23 (16–31) days (p=0.003) as factors associated with increased likelihood of death before discharge.ConclusionsTracheostomy placement in a mixed ICU population is associated with a nearly 20% inpatient mortality and the vast majority of surviving patients were discharged to a care facility. This suggests that the need for tracheostomy could be considered a trigger for re-evaluation of patient goals. The high risk of death due to underlying illness and high intensity care after their hospitalization emphasize the need for clear advanced care planning discussions around the time of tracheostomy placement.Level of EvidenceLevel IV, Retrospective cohort study.

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Tracheostomie in der Palliativmedizin

Fischer

2018

Tracheotomie Und Tracheostomaversorgung

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Impact of a Palliative Care Program on Tracheostomy Utilization in a Community Hospital

Cited by 7 publications

References 10 publications

Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study

Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study

Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care

Tracheostomie in der Palliativmedizin

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