title: What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.
abstract: To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death.
authors: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AK,CLB, KM,DJF).
authors: Ayano
authors: A
authors: Kiyota
authors: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AK,CLB, KM,DJF).
authors: Christina L
authors: CL
authors: Bell
authors: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AK,CLB, KM,DJF).
authors: Kamal
authors: K
authors: Masaki
authors: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AK,CLB, KM,DJF).
authors: Daniel J
authors: DJ
authors: Fischberg
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D006254:Hawaii; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Consultation; Death; Intensive Care Unit; Palliative Care; Prognosis; Referral