title: Effectiveness of integration of palliative medicine specialist services into the intensive care unit of a community teaching hospital.
abstract: BACKGROUND
  Collaboration between palliative medicine and the intensive care unit (ICU) represents best practice and offers important benefits. However, achieving effective collaboration between these two specialties can be challenging.
  
  
  OBJECTIVE
  Assess effectiveness of integrating palliative medicine specialists in the ICU.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Of 201 patients who qualified for palliative consultation using a palliative screening tool, 92 were referred and 109 were not referred for palliative medicine consultation. The number of screening criteria met was similar between the two groups. Palliative medicine consult volume increased significantly compared with preintegration (7.7±3.4 versus 4.4±2.8 consults per month, p=0.04). No significant difference in hospital mortality was found between the referred and unreferred groups (32/92 [35%] versus 26/109 [24%], p=0.09). ICU length of stay was significantly shorter in the referred group (7 versus 11 days, p<0.001). Referred patients were more frequently enrolled in hospice compared with unreferred patients (32/92 [37%] versus 3/109 [3%], p<0.001). ICU physicians referred patients significantly more often for dementia and ventilator withdrawal (13/16, p=0.003; 24/29, p<0.001, respectively) and significantly less often for ICU stay longer than 10 days (21 versus 49, p=0.001).
  
  
  CONCLUSIONS
  Integrating palliative medicine specialists into intensive care was associated with a significant increase in use of palliative medicine services and a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. The screening tool effectively identified patients at high risk of death. Given the high mortality rate of the unreferred patients, the criteria could be more widely adopted by ICU physicians to consider expanding palliative medicine referrals.
authors.affiliation: 1 Department of Medicine, MedStar Union Memorial Hospital , Baltimore, Maryland.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Walker
authors.forename: René L
authors.initials: RL
authors.lastname: Mayo
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Camire
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Kearney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies