Prerna Panjikar, MD
Internal Medicine Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Bohdan Baralo, MD
Resident
Mercy Fitzgerald Hospital
Darby, Pennsylvania
Disclosure information not submitted.
Thomas Alukal, MD
Internal Medicine Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Steven Russell, MD
Assistant Program Director
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Title: The Effects of Early Goal of Care Discussions on the Utilization of Intensive Care Resources
Introduction: 22% of all death in the United States happens in intensive care units (ICU), which cause increased utilization of the ICU resources. The involvement of palliative care is known to improve quality and often the quantity of life for patients with an end-stage condition, and the same time to save healthcare resources. The goal of the study is to determine whether the early goal of care discussion (GOC) can decrease ICU length of stay (LOS), hospital LOS and to assess whether time to code status change (CSC).
Methods: In our study, all patients were divided into two groups: early GOC (the discussion was held before day 6 of ICU stay) and late GOC groups (discussion on day 6 and later). Only patients with more than 1 end-stage condition were included in the study, palliative care involved, and code status change to Do Not Resuscitate (DNR) documented. Patients who remained Full Code, reversal of DNR were excluded from the study. The ICU, hospital LOS and time to CSC were collected in days for every patient. The Man Whitney test was used to analyze the data given the small sample and high potential to have skewed data due to prolonged LOS in some critically ill patients. The statistical software PRISM 9.1 was used to analyze the data.
Results: The chart of 103 patients was reviewed, and 33 patients met all inclusion and no exclusion criteria. Both ICU and hospital LOS were lower in the early GOC group (Mean ICU LOS 10, median 8; Mean hospital LOS 14.4, median 12) compared to the late GOC group (Mean ICU LOS 18.1, median 13.5; Mean hospital LOS 30.8, median 26.5), p 0.007. The time to change the code status was not different between early GOC (Mean time to CSC 6; median 5) and late GOC groups (Mean time to CSC 10.3; median 4), p 0.92.
Conclusions: The early GOC discussion in families of critically ill patients with end-stage conditions leads to the decrease in ICU and hospital LOS. At the same time, initiation of the GOC early did not lead to the more extended period before CSC.