Muhammad Javed, MD, FCCP, FCCM,FCCM
Associate Program Director
Mercy Hospital Saint Louis
Saint Louis, Missouri, United States
Disclosure information not submitted.
Christine Warner, MD
Fellow
Mercy Hospital St Louis, United States
Disclosure information not submitted.
Javad Vaziri, DO
Attending Physician
Mercy Hospital St Louis, United States
Disclosure information not submitted.
Title: Timing of palliative care consultation and Intensive Care Unit (ICU) patient outcomes
Introduction: Early palliative care consultations (PCC) reduce Intensive Care Unit (ICU) admissions, length of stay (LOS), and overall resource utilization. However, PCC often occurs after all treatment options are exhausted. There are no standardized definitions of what constitutes early versus late consultations. Literature review demonstrates heterogeneity of methodologies. Most research studies have been done at academic hospitals and not in community settings.
Objective: To determine the impact of very early (VE), early (E) or late (L) PCC on patient outcomes in a community hospital.
Methods: IRB (Institutional Review Board) approval was obtained per institutional protocol. A retrospective convenience sample was obtained from 2019 to 2020. We selected patients who had PCCs and arranged them into three groups: VE group (days 1-3 from admission), the E group (days 4-7), and the L group ( >7days). Data was de-identified. Patient grouping according to the division scheme above was based on the timing of PCC (documented in the patients' charts). After log 10 transformation of LOS data, comparison of means for the 3 groups of PCC times was performed using ANOVA. p< 0.05 was considered statistically significant.
Results: Total number of patients included in analysis was 207 (n). There was no statistically significant difference in APACHE scores between patients. There was a statistically significant difference (p< 0.05) in ICU length of stay (LOS) if PCC was requested VE compared to L (but not if E compared to L). There was a statistically significant difference (p< 0.05) in hospital LOS if PCC was requested VE compared to E and E compared to L. Each day of delay in PCC lead to an increase in hospital LOS by 0.9 days. Additionally, each day of delay in PCC increased the ICU LOS by 0.8 days. If PCC was delayed past 8 days, there was no difference in hospital or ICU LOS. There was no difference in mortality based on timing of PCC.
Conclusions: When PCC is requested VE (days 1-3) in ICU stay, both hospital LOS and ICU LOS decrease significantly. Our study quantifies day of PCC versus previous studies. Based on these data, we recommend very early PCC perhaps using a protocol-based approach. This would have a direct effect on resource utilization at the end of life.