Michele Iguina
Fellow
Aventura Hospital and Medical Center
Aventura, Florida
Disclosure information not submitted.
Aunie Danyalian
Pulmonary and Critical Care Fellow
Aventura Hospital and Medical Centre
Aventura, Florida
Disclosure information not submitted.
Umair Shaikh, MD
Physician
Aventura Medical Center, United States
Disclosure information not submitted.
Sanaz Kashan, MD, FAAHPM
Hopsice and Palliative Care Fellowship PD
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Mauricio Danckers, MD, FCCP
Pulmonary Medicine and Critical Care Fellowship Faculty
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Title: Integration of Palliative Care Triggers in a Medical-Surgical Intensive Care Unit
Introduction: Integration of palliative care (PC) initiatives in the ICU has been shown to benefit patients and improve outcomes. The aim of this study was to evaluate the clinical characteristics, ICU resource utilization and PC practices of patients with PC triggers in a medical-surgical ICU.
Methods: This retrospective study was conducted in a 44-bed adult, open medical-surgical ICU in a community teaching hospital in Florida. Patients were identified during multidisciplinary rounds (MDR). Eleven PC triggers were selected and approved by our PC expert team. Patients were analyzed based on the presence or absence of PC triggers. Demographic and clinical information, ICU resource utilization and PC practices were collected via review of electronic medical records. Statistical analysis included t-test or Mann-Whitney U test for continuous variables and χ2 test for categorical variables. Logistic regression was done to create a predictive model for presence of PC triggers in patients during their ICU stay.
Results: 388 ICU patients were identified during MDR. 189 patients (48.7%) had at least one PC trigger (trigger group) and 199 (51.3%) did not (non-trigger group). The trigger group had a higher SOFA score and APACHE II score within 24 hours of ICU admission (both p< 0.0001). ICU length of stay greater than 7 days or readmission to ICU (179%) and terminal prognosis (13.5%) were the most common PC triggers. ICU resource utilization was higher in the trigger group with a statistically significant difference in use of vasoactive medications, noninvasive and invasive mechanical ventilation, and renal replacement therapy (all p< 0.05). PC practices were more prevalent in the trigger group including PC team consultation, change to DNR status, palliative extubation and transition to comfort care (all p< 0.001). African American patients were 0.367 times less likely to have presence of PC triggers than White/Hispanic patients. Increasing APACHE II and SOFA score at admission was associated with higher likelihood of meeting PC triggers (χ2(11) = 46.737, p < 0.0001).
Conclusion: PC triggers identified patients with higher disease severity and higher ICU resource utilization. PC practices and outcomes involving goals of care were higher in the trigger group. Race and clinical scoring were predictors of PC triggers presence.