Beyond Infection: Mortality and End-of-Life Care Associated With Infectious Disease Consultation in an Academic...

Area of Science:

• Infectious Diseases
• Palliative Care
• Health Services Research

Background:

• Infectious diseases (ID) physicians face growing challenges managing patients with terminal illnesses and incurable infections.
• The complexity of patients requiring ID consultations has increased significantly over the past decade.

Purpose of the Study:

• To analyze trends in ID consultations over a 10-year period.
• To evaluate the characteristics and outcomes of patients receiving ID consultations, particularly those with end-of-life care needs.
• To examine the integration of palliative care services with ID consultations.

Main Methods:

• Retrospective cohort study of all inpatient ID consults within an academic health system from 2014 to 2023.
• Inclusion of community, general, and transplant ID consult services.
• Analysis of patient demographics, mortality rates, hospice discharges, and palliative care consultations.

Main Results:

• A 94% increase in ID consults was observed, rising from 5.0 to 9.9 per 100 inpatients.
• In-hospital mortality was 7.5% for patients receiving ID consults, with higher rates in transplant ID (10.7%).
• 2.6% of patients were discharged to hospice, and 7.6% received concurrent palliative care consultation, often after the ID consult.

Conclusions:

• Patients receiving ID consultations are increasingly complex and have a higher likelihood of mortality.
• ID clinicians play a crucial role in end-of-life care discussions and planning.
• There is a need to integrate palliative care principles and consultations earlier in the management of complex ID patients.