Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients.
OBJECTIVE
The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU).


METHODS
A prospective pre/post nonequivalent control group design was used for this performance improvement study.


METHODS
Seventeen-bed adult MICU.


METHODS
Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying: 65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteria: a) intensive care admission following a current hospital stay of >or=10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation.


METHODS
Palliative care consultations.


RESULTS
Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge.


CONCLUSIONS
Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.
Norton
Sally A
SA
School of Nursing, University of Rochester Medical Center, Rochester, NY, USA. Sally_Norton@urmc.rochester.edu
Hogan
Laura A
LA
Holloway
Robert G
RG
Temkin-Greener
Helena
H
Buckley
Marcia J
MJ
Quill
Timothy E
TE
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index