title: The relationship between the timing of a palliative care consult and utilization outcomes for ventilator-assisted intensive care unit patients.
abstract: OBJECTIVE
  Given the great number of chronic care patients facing the end of life and the challenges of critical care delivery, there has been emerging evidence supporting the benefit of palliative care in the intensive care unit (ICU). We studied the relationship between the timing of a palliative care consult (PCC) and two utilization outcomes - length of stay (LOS) and pharmacy costs - in ventilator-assisted ICU patients.
  
  
  METHODS
  A retrospective chart review was conducted (N = 90). Summed pharmacy costs were compared using a paired t test before and after PCC. Spearman correlations were performed between days to PCC and ICU LOS, ventilator days, and days to death following ventilator discontinuation.
  
  
  RESULTS
  Number of days from admission to PCC was correlated with total days on ventilator (ρ = 0.685, p < 0.0001) and total ICU LOS (ρ = 0.654, p < 0.0001). Number of days to PCC was correlated with pre-PCC total medication costs (ρ = 0.539, p < 0.0001). Median medication costs were significantly reduced after the PCC (p < 0.0001), from $230.96 to 30.62. Median medication costs decreased for all categories except for analgesics, antiemetics, and opioids. The number of patients receiving opioid infusion increased (37 vs. 90%) after PCC (p < 0.0001).
  
  
  CONCLUSIONS
  Earlier timing for PCC in the ICU is associated with a lower LOS through quicker mechanical ventilation (MV) withdrawal, presenting a unique opportunity to both decrease costs and improve patient care.
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Salonie
authors.initials: S
authors.lastname: Pereira
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kozikowski
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Sunday
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Mir
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Maha
authors.initials: M
authors.lastname: Saad
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Corrado
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Gisele
authors.initials: G
authors.lastname: Wolf-Klein
mesh_terms: D000368:Aged; D003363:Cost Control; D016527:Drug Costs; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010166:Palliative Care; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors; D028761:Withholding Treatment
keywords: Pharmacy costs