Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network (GP723)

Outcomes. 1. Understand how, when, and for which patients palliative care (PC) is currently provided in the ICU and how it differs from medical-surgical units 2. Interpret consultation differences and discuss implications for PC delivery in the ICU versus medical surgical ward setting Importance. Palliative care (PC) has been shown to benefit critically ill patients but remains underused. To develop interventions to overcome barriers to PC in the ICU and address PC needs for ICU patients, we must better understand how, when, and for which patients PC is currently provided in the ICU and how it differs from medical-surgical units. Objective(s). What are the characteristics of specialty PC consultations in the ICU, and how do they differ from medical-surgical consultations? Method(s). Retrospective analysis of PCQN data for inpatients receiving specialty PC consultation between 2013 and 2019. 98 inpatient PC teams representing hospitals in 16 states contributed data. Participants included patients receiving PC consultation in the ICU or medical-surgical setting during the study period. Measures and outcomes included patient characteristics, consultation features, process metrics, and outcomes of care. Mixed effects multivariable logistic regression was performed. For each outcome variable, age, gender, and diagnosis were included as fixed and PC team as random effects. Results. 102,597 patients were included (63,082 medical-surgical and 39,515 ICU). ICU patients were younger (68.4 vs 72.0), less likely to be female (45.4% vs 52.0%), and more likely to have a noncancer diagnosis (cancer diagnosis 15.0% vs 40.9%) and had poorer function. ICU PC consults were more likely for goals of care (GOC) (80.6% vs 75.0%). ICU patients were less likely to be able to report symptoms at consultation. Both groups reported improvements in symptoms. Fewer ICU patients were discharged alive (56.7% vs 87.1%), and ICU patients were less likely to discharge home (31.2% vs 49.5%) (all p < 0.0001). Conclusion(s). Patients in the ICU who receive PC consultation are more likely to have noncancer diagnoses and be less likely able to communicate. Although symptom management and GOC are a standard part of ICU care, specialty PC in the ICU was often engaged for these issues, suggesting that routine interventions targeting these needs could improve care. Impact. ICU patients and teams have unique PC needs, and interventions directed at these needs could improve care quality.