title: Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.
  
  
  METHODS
  A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.
  
  
  RESULTS
  Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2 test, p < 0.0001).
  
  
  CONCLUSIONS
  Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.
authors: North Shore-LIJ Health System, Great Neck, New York, USA. lustbader@nsuh.edu
authors: Dana
authors: D
authors: Lustbader
authors: Renee
authors: R
authors: Pekmezaris
authors: Michael
authors: M
authors: Frankenthaler
authors: Rajni
authors: R
authors: Walia
authors: Frederick
authors: F
authors: Smith
authors: Erfan
authors: E
authors: Hussain
authors: Barbara
authors: B
authors: Napolitano
authors: Martin
authors: M
authors: Lesser
mesh_terms: D018806:APACHE; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D018447:Medical Futility; D010166:Palliative Care; D012017:Referral and Consultation; D016414:Resuscitation Orders; D012189:Retrospective Studies