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Prospective study of a proactive palliative care rounding intervention in a medical ICU

Nicholas Braus| Toby C. Campbell| Kristine L. Kwekkeboom| Susan Ferguson| Carrie Harvey| Anna E. Krupp| Tara Lohmeier| Michael D. Repplinger| Ryan P. Westergaard| Elizabeth A. Jacobs| Kate Ford Roberts| William J. Ehlenbach
Original
Volume 42, Issue 1 / January , 2016

Pages 54 - 62

Abstract

Purpose

To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.

Methods

Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients.

Results

One hundred patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63 % higher (RR 1.63, 95 % CI 1.14–2.07, p = 0.01), and time to family meeting was 41 % shorter (95 % CI 52–28 % shorter, p < 0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6 % shorter, 95 % CI 16 % shorter to 4 % longer, p = 0.22). Among those who died in the hospital, ICU LOS was 19 % shorter in the intervention (95 % CI 33–1% shorter, p = 0.043). Adjusted hospital LOS was 26 % shorter (95 % CI 31–20 % shorter, p < 0.001) with the intervention. Post-traumatic stress disorder (PTSD) symptoms were present in 9.1 % of family respondents during the intervention versus 20.7 % prior to the intervention (p = 0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups.

Conclusions

Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.

Keywords

References

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