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Impact of Intensivist Authority on End-of-Life Practices in a Korean PICU

Yeonhee Lee1, Kyeong Hun Lee2, Boyeon Gu3

  • 1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Clinical Pediatrics
|December 26, 2025
PubMed

Insights

Intensivist-led care in the pediatric intensive care unit (PICU) improves end-of-life (EOL) decision-making. This approach enhances documentation and reduces aggressive interventions, ensuring better quality care for children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Palliative Care
  • Healthcare Management

Background:

  • Effective end-of-life (EOL) decision-making is crucial for quality care in pediatric intensive care units (PICUs).
  • The role of intensivist-led care in structuring EOL practices requires further evaluation.

Purpose of the Study:

  • To assess the impact of intensivist-led care on the timing and structure of EOL practices in a PICU.
  • To compare EOL outcomes across different levels of intensivist involvement.

Main Methods:

  • Retrospective review of 39 pediatric intensive care unit deaths over 3 years.
  • Categorization of patient care into pre-intensivist, passive-intensivist, and active-intensivist periods.
  • Analysis of Physician Orders for Life-Sustaining Treatment (POLST) and Do Not Resuscitate (DNR) completion rates, time from decision to death, and cardiopulmonary resuscitation (CPR)-related deaths.

Main Results:

  • Physician Orders for Life-Sustaining Treatment (POLST) completion increased significantly to 100% in the active-intensivist period (P < .01).
  • Cardiopulmonary resuscitation (CPR)-related deaths decreased to 6.7% in the active-intensivist period (P = .044), with 93.3% experiencing no escalation of support.
  • Time from decision to death increased to 5.0 days (P = .038), indicating more structured EOL discussions.

Conclusions:

  • Intensivist-led care significantly enhances end-of-life (EOL) documentation, specifically Physician Orders for Life-Sustaining Treatment (POLST).
  • This model of care reduces aggressive interventions and promotes structured EOL practices, improving care quality in the PICU.
  • Active intensivist involvement facilitates timely and appropriate end-of-life care decisions.

Keywords:
deathpediatric intensive care unitspediatricsresuscitation ordersterminal care

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