title: Impact of Palliative Care Screening and Consultation in the ICU: A Multihospital Quality Improvement Project.
abstract: There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU).
  
  
  
  To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria.
  
  
  
  In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates. For patients with and without PCCs, outcomes studied were as follows: 1) change to "do not resuscitate" (DNR), 2) discharge to hospice, 3) 30-day readmission, 4) hospital length of stay (LOS), 5) total direct hospital costs.
  
  
  
  In 405 patients with positive screens, 161 (40%) who received a PCC were compared to 244 who did not. Patients receiving PCCs had higher rates of DNR-adjusted odds ratio (AOR) = 7.5; 95% CI 5.6-9.9) and hospice referrals-(AOR = 7.6; 95% CI 5.0-11.7). They had slightly lower 30-day readmissions-(AOR = 0.7; 95% CI 0.5-1.0); no overall difference in direct costs or LOS was found between the two groups. When patients receiving PCCs were stratified by time to PCC initiation, early consultation-by Day 4 of admission-was associated with reductions in LOS (1.7 days [95% CI -3.1, -1.2]) and average direct variable costs (-$1815 [95% CI -$3322, -$803]) compared to those who received no PCC.
  
  
  
  Receiving a PCC in the ICUs was significantly associated with more frequent DNR code status and hospice referrals, but not 30-day readmissions or hospital utilization. Early PCC was associated with significant LOS and direct cost reductions. Providing PCC early in the ICU should be considered.
authors.affiliation: Wayne State University, Detroit, Michigan, USA; Tenet Healthcare, Dallas, Texas, USA. Electronic address: rzalensk@med.wayne.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Zalenski
authors.affiliation: Tenet Healthcare, Dallas, Texas, USA.
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Jones
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Courage
authors.affiliation: St. Johns Providence Hospital, Warren, Michigan, USA.
authors.forename: Denise R
authors.initials: DR
authors.lastname: Waselewsky
authors.affiliation: DMC Harper Hospital, Detroit, Michigan, USA.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kostaroff
authors.affiliation: Tenet Healthcare, Dallas, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kaufman
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Afzal
authors.initials: A
authors.lastname: Beemath
authors.affiliation: MacNeal Hospital, Berwyn, Illinois, USA.
authors.forename: John
authors.initials: J
authors.lastname: Brofman
authors.affiliation: University of Texas Rio Grande Valley, Edinburg, Texas, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Castillo
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Hicham
authors.initials: H
authors.lastname: Krayem
authors.affiliation: West Suburban Medical Center, Chicago, Illinois, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Marinelli
authors.affiliation: Tenet Healthcare, Dallas, Texas, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Milner
authors.affiliation: DMC Harper Hospital, Detroit, Michigan, USA; American Hospital Dubai, United Arab Emirates.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Palleschi
authors.affiliation: American Hospital Dubai, United Arab Emirates.
authors.forename: Mona
authors.initials: M
authors.lastname: Tareen
authors.affiliation: Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Testani
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Ayman
authors.initials: A
authors.lastname: Soubani
authors.affiliation: Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Walch
authors.affiliation: Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Wheeler
authors.affiliation: Detroit Medical Center, Detroit, Michigan, USA; Seasons Hospice and Palliative Care, Madison Heights, Michigan, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Wilborn
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Hanna
authors.initials: H
authors.lastname: Granovsky
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D010359:Patient Readmission; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation
keywords: Palliative care consultation; consult trigger tool; direct variable costs; do not resuscitate code change; intensive care unit; length of stay