Early palliative care consultation in the medical ICU: A cluster randomized crossover trial.
Open accessAbstract
Objectives: To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients. Design: Single-center cluster randomized crossover trial. Setting: Two medical ICUs at Barnes Jewish Hospital. Patients: Patients ( n = 199) admitted to the medical ICUs from August 2017 to May 2018 with a positive palliative care screen indicating high risk for morbidity or mortality. Interventions: The medical ICUs were randomized to intervention or usual care followed by washout and crossover, with independent assignment of patients to each ICU at admission. Intervention arm patients received a palliative care consultation from an interprofessional team led by board-certified palliative care providers within 48 hours of ICU admission. Measurements and Main Results: Ninety-seven patients (48.7%) were assigned to the intervention and 102 (51.3%) to usual care. Transition to do-not-resuscitate/do-not-intubate occurred earlier and significantly more often in the intervention group than the control group (50.5% vs 23.4%; p < 0.0001). The intervention group had significantly more transfers to hospice care (18.6% vs 4.9%; p < 0.01) with fewer ventilator days (median 4 vs 6 d; p < 0.05), tracheostomies performed (1% vs 7.8%; p < 0.05), and postdischarge emergency department visits and/or readmissions (17.3% vs 38.9%; p < 0.01). Although total operating cost was not significantly different, medical ICU ( p < 0.01) and pharmacy ( p < 0.05) operating costs were significantly lower in the intervention group. There was no significant difference in ICU length of stay (median 5 vs 5.5 d), hospital length of stay (median 10 vs 11 d), in-hospital mortality (22.6% vs 29.4%), or 30-day mortality between groups (35.1% vs 36.3%) ( p > 0.05). Conclusions: Early triggered palliative care consultation was associated with greater transition to do-not-resuscitate/do-not-intubate and to hospice care, as well as decreased ICU and post-ICU healthcare resource utilization. Our study suggests that routine palliative care consultation may positively impact the care of high risk, critically ill patients.
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Prone position was associated with an increase in pressure sores.
“However, prone position was associated with an increase in pressure sores (RR, 1.22; 95% CI, 1.05-1.41)(460, 461), and some patients have contraindications to the prone position (460, 461).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [461]
The Methods (Trial Outcomes; page unavailable) lists palliative-care outcomes, and the Results report code-status changes, hospice transfers, and resource use. Searches for prone positioning, pressure sores or ulcers, and the stated risk ratio found no passage addressing the claim in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredPalliative care interventions have been studied in ICU patients, but not specifically in patients with sepsis.
“Studies have evaluated palliative care interventions in the ICU but not specifically in patients with sepsis [543, 545–548].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [548]
Palliative care interventions had no significant impact on family satisfaction, ICU length of stay, hospital length of stay, or mortality.
“Palliative care interventions had no significant impact on family satisfaction with care, ICU length of stay [543, 545–548], hospital length of stay [543, 545, 548], or mortality [543, 545, 548].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [548]
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Palliative care consultation and end-of-life outcomes in hospitalized COVID-19 patients
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Zusammenarbeit von Intensivmedizin und Palliativmedizin
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The Impact of Integrating Palliative Medicine Into COVID-19 Critical Care
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Ethics in disaster, mass casualty care, and critical care
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Artificial intelligence-based approaches for advance care planning: a scoping review
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Retrospective Review of Trauma ICU Patients With and Without Palliative Care Intervention
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Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19
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Palliative Care in the Intensive Care Unit: The Standard of Care
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Trends in Palliative Care Consultations in Critically Ill Patient Populations, 2013-2019
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Opportunities to Improve Palliative Care Delivery in Trauma Critical Illness
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Premorbid Clinical Frailty Score and 30‐day mortality among older adults in the emergency department
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Broad-Spectrum Antibiotic Use at the End of Life in Patients With Advanced Cancer
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Frailty and Preoperative Palliative Care in Surgical Oncology
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Early palliative intervention in septic patients reduces healthcare utilization
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Unmet palliative care service needs: a patient-centred metric
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Entscheidungen am Lebensende und Palliativtherapie in der Intensivmedizin
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Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU
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Ethisch begründet entscheiden in der Intensivmedizin
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Palliative Care Consult Among Older Adult Patients in Intensive Care Units
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Futile care and burnout in intensive care unit nurses
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Palliative Care Consultation and Cost of Stay in out of Hospital Cardiac Arrest
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Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs
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S1-Leitlinie Nachhaltigkeit in der Intensiv- und Notfallmedizin
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Intensive care unit interventions to improve quality of dying and death: scoping review
Naya, K., Sakuramoto, H., Aikawa, G., Ouchi, A., Oyama, Y., Tanaka, Y., Kaneko, K., Fukushima, A., & Ota, Y. (2024) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2024-004967 · Cited by 3 · see citing works
- Authors
- Ma, J., Chi, S., Buettner, B., Pollard, K., Muir, M., Kolekar, C., Al-Hammadi, N., Chen, L., Kollef, M., & Dans, M.
- Affiliations
- Duke University (US)
- Washington University in St. Louis (US)
- Venue
- Critical Care Medicine
- Published
- 2019-12
- Volume
- 47
- Issue
- 12
- Pages
- 1707-1715
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC6861688
- OpenAlex
- W2980544752
- Semantic Scholar
- ec6665a0529067c85c4be1d796ab72edd607512e
- Cited by
- 166
- References
- 49
- Citations by year
- 2026: 23 · 2025: 31 · 2024: 28 · 2023: 21 · 2022: 26 · 2021: 24 · 2020: 11 · 2019: 1
- FWCI
- 14.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002345)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- medical intensive care unit, do-not-resuscitate orders, do-not-intubate orders, healthcare resource utilization, ventilator days, tracheostomy, post-discharge readmission, in-hospital mortality, operating costs, palliative care screening, end-of-life care
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Intensive Care Units, Male, Middle Aged, Palliative Care, Prospective Studies, Referral and Consultation, Critical Illness, Cross-Over Studies, Early Medical Intervention
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