Effectiveness of integration of palliative medicine specialist services into the intensive care unit of a community teaching hospital.

MedStar author(s):
Citation: Journal of Palliative Medicine. 16(10):1237-41, 2013 Oct.PMID: 24032755Institution: MedStar Union Memorial HospitalDepartment: MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Critical Care/og [Organization & Administration] | *Delivery of Health Care, Integrated/og [Organization & Administration] | *Hospitals, Community/og [Organization & Administration] | *Intensive Care Units/og [Organization & Administration] | *Palliative Care/og [Organization & Administration] | Adult | Aged | Aged, 80 and over | Female | Hospital Mortality | Humans | Length of Stay/sn [Statistics & Numerical Data] | Male | Middle Aged | Referral and Consultation/sn [Statistics & Numerical Data] | Retrospective StudiesYear: 2013Local holdings: Available online through MWHC library: 2013 to the presentISSN:
  • 1557-7740
Name of journal: Journal of palliative medicineAbstract: BACKGROUND: Collaboration between palliative medicine and the intensive care unit (ICU) represents best practice and offers important benefits. However, achieving effective collaboration between these two specialties can be challenging.CONCLUSIONS: Integrating palliative medicine specialists into intensive care was associated with a significant increase in use of palliative medicine services and a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. The screening tool effectively identified patients at high risk of death. Given the high mortality rate of the unreferred patients, the criteria could be more widely adopted by ICU physicians to consider expanding palliative medicine referrals.DESIGN: Retrospective chart review.OBJECTIVE: Assess effectiveness of integrating palliative medicine specialists in the ICU.RESULTS: Of 201 patients who qualified for palliative consultation using a palliative screening tool, 92 were referred and 109 were not referred for palliative medicine consultation. The number of screening criteria met was similar between the two groups. Palliative medicine consult volume increased significantly compared with preintegration (7.7+/-3.4 versus 4.4+/-2.8 consults per month, p=0.04). No significant difference in hospital mortality was found between the referred and unreferred groups (32/92 [35%] versus 26/109 [24%], p=0.09). ICU length of stay was significantly shorter in the referred group (7 versus 11 days, p<0.001). Referred patients were more frequently enrolled in hospice compared with unreferred patients (32/92 [37%] versus 3/109 [3%], p<0.001). ICU physicians referred patients significantly more often for dementia and ventilator withdrawal (13/16, p=0.003; 24/29, p<0.001, respectively) and significantly less often for ICU stay longer than 10 days (21 versus 49, p=0.001).All authors: Camire LM, Kearney CD, Mayo RL, Walker KAFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2016-07-15
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 24032755 Available 24032755

Available online through MWHC library: 2013 to the present

BACKGROUND: Collaboration between palliative medicine and the intensive care unit (ICU) represents best practice and offers important benefits. However, achieving effective collaboration between these two specialties can be challenging.

CONCLUSIONS: Integrating palliative medicine specialists into intensive care was associated with a significant increase in use of palliative medicine services and a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. The screening tool effectively identified patients at high risk of death. Given the high mortality rate of the unreferred patients, the criteria could be more widely adopted by ICU physicians to consider expanding palliative medicine referrals.

DESIGN: Retrospective chart review.

OBJECTIVE: Assess effectiveness of integrating palliative medicine specialists in the ICU.

RESULTS: Of 201 patients who qualified for palliative consultation using a palliative screening tool, 92 were referred and 109 were not referred for palliative medicine consultation. The number of screening criteria met was similar between the two groups. Palliative medicine consult volume increased significantly compared with preintegration (7.7+/-3.4 versus 4.4+/-2.8 consults per month, p=0.04). No significant difference in hospital mortality was found between the referred and unreferred groups (32/92 [35%] versus 26/109 [24%], p=0.09). ICU length of stay was significantly shorter in the referred group (7 versus 11 days, p<0.001). Referred patients were more frequently enrolled in hospice compared with unreferred patients (32/92 [37%] versus 3/109 [3%], p<0.001). ICU physicians referred patients significantly more often for dementia and ventilator withdrawal (13/16, p=0.003; 24/29, p<0.001, respectively) and significantly less often for ICU stay longer than 10 days (21 versus 49, p=0.001).

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