title: Patterns of palliative care service consultation in a sample of critically ill ICU patients at high risk of dying.
abstract: OBJECTIVE
  Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying.
  
  
  BACKGROUND
  Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes.
  
  
  METHODS
  From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation.
  
  
  RESULTS
  About half (773/1440 [54%]) were at high risk of dying or died, 73 (9.4%) of whom received palliative care consultation. On average, referral occurred after 62% of the ICU stay had elapsed. Primary reason for consult was clarification of goals of care (52/73 [72.2%]).
  
  
  CONCLUSIONS
  Among MV ICU patients at high risk of dying, palliative care service consultation occurs late and infrequently, suggesting a role for earlier palliative care.
authors.affiliation: The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 607 Scaife Hall, 3550 Terrace St., Pittsburgh, PA 15261, USA. Electronic address: jbs31@pitt.edu.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Seaman
authors.affiliation: Section of Decision Sciences, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600.13, Pittsburgh, PA 15213, USA.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato
authors.affiliation: Department of Health and Community Systems, University of Pittsburgh School of Nursing, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15216, USA; Center for Research and Evaluation, University of Pittsburg School of Nursing, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15216, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.affiliation: Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, 352 Newton Hall, 1585 Neil Ave, Columbus, OH 43210, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Happ
authors.affiliation: Department of Health and Community Systems, University of Pittsburgh School of Nursing, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15216, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Erlen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards*; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Critical care; End-of-life care; Palliative care; Patient-centered outcomes; Quality of health care