Integrating Palliative Care into Critical Care: A Quality Improvement Study

Area of Science:

• Medical Intensive Care
• Palliative Care Medicine
• Health Services Research

Background:

• Terminally ill patients often receive care intensity misaligned with preferences.
• Palliative care consultation (PCC) was introduced in a medical intensive care unit (ICU) in 2009.
• This study investigates clinical and economic outcomes of PCC in the ICU.

Purpose of the Study:

• To compare clinical and economic outcomes between ICU patients who received PCC and those who did not.
• To evaluate the impact of PCC on patient acuity, length of stay, mortality, and costs.
• To inform the utilization of PCC services in critical care settings.

Main Methods:

• Retrospective review of ICU admissions between July and October 2010.
• Comparison of 41 patients who received PCC with 80 randomly selected controls who did not.
• Measurement of clinical outcomes and economic variables, including ICU length of stay and total hospital charges.

Main Results:

• PCC patients were older and had higher disease acuity (APACHE IV scores).
• PCC patients experienced longer ICU stays and higher ICU mortality rates.
• Median total hospital charges were higher for PCC patients, but daily ICU charges were similar after adjustment.

Conclusions:

• PCC patients exhibited higher acuity, longer ICU stays, and increased mortality.
• Implementing "trigger" programs may enhance PCC utilization and patient comfort.
• PCC may help reduce potentially futile end-of-life care in the ICU.