title: A Randomized Trial of Palliative Care Discussions Linked to an Automated Early Warning System Alert.
abstract: OBJECTIVE
  To determine whether an Early Warning System could identify patients wishing to focus on palliative care measures.
  
  
  METHODS
  Prospective, randomized, pilot study.
  
  
  METHODS
  Barnes-Jewish Hospital, Saint Louis, MO (January 15, 2015, to December 12, 2015).
  
  
  METHODS
  A total of 206 patients; 89 intervention (43.2%) and 117 controls (56.8%).
  
  
  METHODS
  Palliative care in high-risk patients targeted by an Early Warning System.
  
  
  RESULTS
  Advanced directive documentation was significantly greater prior to discharge in the intervention group (37.1% vs 15.4%; p < 0.001) as were first-time requests for advanced directive documentation (14.6% vs 0.0%; p < 0.001). Documentation of resuscitation status was also greater prior to discharge in the intervention group (36.0% vs 23.1%; p = 0.043). There was no difference in the number of patients requesting a change in resuscitation status between groups (11.2% vs 9.4%; p = 0.666). However, changes in resuscitation status occurred earlier and on the general medicine units for the intervention group compared to the control group. The number of patients transferred to an ICU was significantly lower for intervention patients (12.4% vs 27.4%; p = 0.009). The median (interquartile range) ICU length of stay was significantly less for the intervention group (0 [0-0] vs 0 [0-1] d; p = 0.014). Hospital mortality was similar (12.4% vs 10.3%; p = 0.635).
  
  
  CONCLUSIONS
  This study suggests that automated Early Warning System alerts can identify patients potentially benefitting from directed palliative care discussions and reduce the number of ICU transfers.
authors: 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 2Palliative Care Services, Department of Medicine, Barnes-Jewish Hospital, St. Louis, MO. 3Center for Clinical Excellence, BJC HealthCare, St. Louis, MO. 4Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 5Department of Medicine, School of Engineering and Applied Sciences, Washington University in St. Louis, St. Louis, MO.
authors: David
authors: D
authors: Picker
authors: Maria
authors: M
authors: Dans
authors: Kevin
authors: K
authors: Heard
authors: Thomas
authors: T
authors: Bailey
authors: Yixin
authors: Y
authors: Chen
authors: Chenyang
authors: C
authors: Lu
authors: Marin H
authors: MH
authors: Kollef
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000465:Algorithms; D056902:Clinical Alarms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012151:Resuscitation / Q000706:statistics & numerical data