title: Integration of Palliative Care Advanced Practice Nurses Into Intensive Care Unit Teams.
abstract: BACKGROUND
  Referrals to palliative care for patients at the end of life in the intensive care unit (ICU) often happen late in the ICU stay, if at all. The integration of a palliative medicine advanced practice nurse (APN) is one potential strategy for proactively identifying patients who could benefit from this service.
  
  
  OBJECTIVE
  To evaluate the association between the integration of palliative medicine APNs into the routine operations of ICUs and hospital costs at 2 different institutions, Montefiore Medical Center (MMC) and Rush University Medical Center.
  
  
  METHODS
  The association between collaborative palliative care consultation service programs and hospital costs per patient was evaluated for the 2 institutions. Hospital costs were compared for patients with and without a referral to palliative care using Mann-Whitney U tests.
  
  
  RESULTS
  Hospital nonroom and board costs at the Weiler campus of MMC were significantly lower for patients with palliative care compared with those who did not receive palliative care (Median = US$6643 vs US$12 399, P < .001). Cost differences for ICU patients with and without palliative care at Rush University Medical Center were not significantly different.
  
  
  CONCLUSIONS
  Our evaluation suggests that the integration of APNs into a palliative care team for case finding may be a promising strategy, but more work is needed to determine whether reductions in cost are significant.
authors.affiliation: 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Mahony
authors.affiliation: 2 Department of Health Systems Management, Rush University, Chicago, IL, USA.
authors.forename: Tricia J
authors.initials: TJ
authors.lastname: Johnson
authors.affiliation: 2 Department of Health Systems Management, Rush University, Chicago, IL, USA.|3 Palliative Care Service, OhioHealth, Columbus, OH, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Amer
authors.affiliation: 4 College of Nursing, Columbia University Medical Center, New York City, NY, USA.
authors.forename: Marlene E
authors.initials: ME
authors.lastname: McHugh
authors.affiliation: 5 Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: McHenry
authors.affiliation: 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Fosler
authors.affiliation: 6 Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kvetan
mesh_terms: D057179:Advanced Practice Nursing / Q000191:economics / Q000458:organization & administration*; D000368:Aged; D003299:Cooperative Behavior; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*
keywords: advanced practice provider; economics; health care costs; palliative care; palliative care consultation; team-based care