Cited by 166Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics in medical practice

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Early palliative care consultation in the medical ICU: A cluster randomized crossover trial.

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Ma, Jessica, Chi, Stephen, Buettner, Benjamin, Pollard, Katherine, Muir, Monica, Kolekar, Charu, Al-Hammadi, Noor, Chen, Ling, Kollef, Marin, Dans, Maria·2019·Critical Care Medicine

DOI 10.1097/ccm.0000000000004016PMC PMC6861688

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Abstract

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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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)
ORCID: Ma, Jessica
Pollard, Katherine
Al-Hammadi, Noor
Chen, Ling
Kollef, Marin
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2019-12
Volume: 47
Issue: 12
Pages: 1707-1715
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0000000000004016
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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Early palliative care consultation in the medical ICU: A cluster randomized crossover trial.

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