title: Prospective study of a proactive palliative care rounding intervention in a medical ICU.
abstract: OBJECTIVE
  To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Braus
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Toby C
authors.initials: TC
authors.lastname: Campbell
authors.affiliation: School of Nursing, University of Wisconsin, Madison, WI, USA.
authors.forename: Kristine L
authors.initials: KL
authors.lastname: Kwekkeboom
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Harvey
authors.affiliation: School of Nursing, University of Wisconsin, Madison, WI, USA.|University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Krupp
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Lohmeier
authors.affiliation: Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Repplinger
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Kate Ford
authors.initials: KF
authors.lastname: Roberts
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine, Allergy and Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 5230 Medical Foundation Centennial Building, 1685 Highland Avenue, mail code 2281, Madison, WI, 53705-2281, USA. wjehlen@medicine.wisc.edu.
authors.forename: William J
authors.identifier: http://orcid.org/0000-0002-2864-5543
authors.initials: WJ
authors.lastname: Ehlenbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011368:Professional-Family Relations; D011446:Prospective Studies; D013727:Terminal Care / Q000458:organization & administration*
keywords: Communication; End-of-life care; Family ICU syndrome; Family meetings; ICU decision-making; Palliative care