Abstract
Objective
To describe a physician (MD) and registered nurse (RN) led palliative care consultation
team embedded in the medical intensive care unit (MICU). To compare patterns of palliative
care consultation, and rates of goals of care documentation and in-ICU mortality before
and after the implementation of the embedded team.
Context
By embedding MD/RN palliative care team in the MICU, more critically ill patients
with unmet palliative care needs could receive an earlier palliative care consultation.
Methods
In a retrospective cohort study of patients admitted to the MICU who received a palliative
care consultation, we compared sociodemographic and clinical characteristics of patients
who received a referral-based consultation (01/01/2019-06/30/2019) and those who received
an embedded MD/RN consult (09/01/2019-02/28/2020). Using the electronic health record
data, we compared palliative care consultation characteristics, rates of documentation
of medical decision-maker and goals of care, and percentage of in-ICU mortality between
the referral group and the embedded group.
Results
In a six-month period, 169 MICU patients received an embedded consultation, as compared
to 52 MICU patients who received a referral-based consultation. As compared to the
referral-based period, those patients who received an embedded consult were seen significantly
earlier in hospitalization (median number of days from hospital admission to consult:
10 days [pre] vs. 3 days [embedded], P<0.001), more likely to have documentation of medical decision-makers (40% [pre] vs.
66% [embedded], P=0.002) and goals of care (37% [pre] vs. 71% [embedded], P<0.001) and less likely to die in the hospital (75% [pre] vs. 44% [embedded], P<0.001).
Conclusions
After embedding a palliative care MD/RN team into the MICU, patients received earlier
palliative care consultation, were more likely to have medical decision-maker and
goals of care documented, and less likely to die in the hospital. Future work will
examine how to adapt this model to other ICUs to improve palliative care access for
critically ill patients broadly.
Key Words
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Article info
Publication history
Published online: December 27, 2022
Accepted:
December 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Editorial Comment: David Hui, MD, MSc, FAAHPM. Associate Editor.
This quality improvement project conducted prior to the pandemic reported an increase in goals of care discussion and reduction in intensive care unit mortality after embedding a palliative care team, highlighting opportunities for collaboration to improve patient care.
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
