title: Impact of a Palliative Care Program on Tracheostomy Utilization in a Community Hospital.
abstract: BACKGROUND
  Tracheostomies are typically provided to wean patients off the ventilator. However, in many circumstances tracheostomies are placed in patients who are at the end of their life with little hope of meaningful recovery. Palliative care teams decrease utilization of aggressive medical interventions in patients who are at the end of life.
  
  
  OBJECTIVE
  The study objective was to determine the impact of a palliative care team on tracheostomy utilization in a community hospital setting.
  
  
  METHODS
  The study was a four-year retrospective analysis of adult patients undergoing elective tracheostomy two years before and after the establishment of a palliative care program. The study in an ethnically diverse community hospital included patients older than 18 years old, with patients undergoing a tracheostomy due to trauma excluded. Before and after comparisons were made of demographics, in-hospital mortality, length of stay, and discharge status of patients undergoing tracheostomy.
  
  
  RESULTS
  Seven hundred ninety patients undergoing tracheostomy were identified (n = 406, n = 384 before and after September 10, 2010, respectively). Patients were ethnically diverse (Caucasian 43%, Asian 23%, African American 11%, Hispanic 7%). The number of hospital admissions slightly increased during these two time periods (n = 58,926; n = 60,662, respectively). There were no statistical differences in age (73 versus 72, p = 0.827); gender (n = 218 [54%] versus n = 217 [57%] male, p = 0.426); or race (n = 187 [46%] versus n = 150 [39%] Caucasian, p = 0.073) in the two time periods. Patients who underwent tracheostomy after a palliative care service was established had less incidence of comorbid disease (Charlson Comorbidity Index score [CCIS]: 2 versus 3, p = 0.025); lower inpatient mortality (n = 107 [28%] versus n = 148 [37%], p = 0.009]); greater discharge to home or rehabilitation (n = 262 [68%] versus n = 249 [62%], p = 0.01); and lower rates of palliative weaning from mechanical ventilation (n = 61[16%] versus n = 113 [28%], p < 0.001).
  
  
  CONCLUSIONS
  In an ethnically diverse community hospital, the institution of a palliative care program appears to have improved patient selection for tracheostomy with lower rates of inpatient mortality, improved rates of home discharge, and lower rates of palliative weaning from mechanical ventilation.
authors.affiliation: 1 Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.|2 Division of Geriatrics and Palliative Care Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Cynthia X
authors.initials: CX
authors.lastname: Pan
authors.affiliation: 1 Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.|3 Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: 2 Division of Geriatrics and Palliative Care Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Min M
authors.initials: MM
authors.lastname: Maw
authors.affiliation: 4 Division of Thoracic Surgery-Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Kansler
authors.affiliation: 1 Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Liam
authors.initials: L
authors.lastname: Gross
authors.affiliation: 1 Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Jie
authors.initials: J
authors.lastname: He
authors.affiliation: 2 Division of Geriatrics and Palliative Care Medicine, New York Presbyterian Hospital-Weill Cornell Medical College , New York, New York.
authors.forename: Romana
authors.initials: R
authors.lastname: Kanta
authors.affiliation: 5 Thoracic Surgical Services , Barnabas Health, Livingston, New Jersey.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009518:New York; D010166:Palliative Care / Q000379:methods* / Q000639:trends; D010351:Patient Discharge / Q000639:trends; D057240:Patient Preference / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D017678:Sex Distribution; D013727:Terminal Care / Q000379:methods / Q000639:trends*; D014139:Tracheostomy / Q000639:trends*; D015300:Ventilator Weaning / Q000379:methods / Q000639:trends*