Journal article
Prospective study of a proactive palliative care rounding intervention in a medical ICU
Intensive care medicine, Vol.42(1), pp.54-62
01/01/2016
DOI: 10.1007/s00134-015-4098-1
PMCID: PMC4945103
PMID: 26556622
Abstract
To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.
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.
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.
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.
Details
- Title: Subtitle
- Prospective study of a proactive palliative care rounding intervention in a medical ICU
- Creators
- Nicholas Braus - University of Wisconsin–MadisonToby C Campbell - University of Wisconsin–MadisonKristine L Kwekkeboom - University of Wisconsin–MadisonSusan Ferguson - University of Wisconsin–MadisonCarrie Harvey - University of MichiganAnna E Krupp - University of Wisconsin–MadisonTara Lohmeier - University of Wisconsin–MadisonMichael D Repplinger - University of Wisconsin–MadisonRyan P Westergaard - University of Wisconsin–MadisonElizabeth A Jacobs - University of Wisconsin–MadisonKate Ford Roberts - UW Health University HospitalWilliam J Ehlenbach - University of Wisconsin–Madison
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.42(1), pp.54-62
- DOI
- 10.1007/s00134-015-4098-1
- PMID
- 26556622
- PMCID
- PMC4945103
- NLM abbreviation
- Intensive Care Med
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Grant note
- K23 AG038352 / NIA NIH HHS UL1 TR000427 / NCATS NIH HHS UL1TR000427 / NCATS NIH HHS
- Language
- English
- Date published
- 01/01/2016
- Academic Unit
- Nursing
- Record Identifier
- 9984370742302771
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