Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients
OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU). DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study...
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| Veröffentlicht in: | Critical care medicine 2007-06, Vol.35 (6), p.1530-1535 |
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| container_title | Critical care medicine |
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| creator | Norton, Sally A Hogan, Laura A Holloway, Robert G Temkin-Greener, Helena Buckley, Marcia J Quill, Timothy E |
| description | OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU).
DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study.
SETTING:Seventeen-bed adult MICU.
PATIENTS:Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteriaa) intensive care admission following a current hospital stay of ≥10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation.
INTERVENTIONS:Palliative care consultations.
MEASUREMENTS AND MAIN RESULTS:Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge.
CONCLUSIONS:Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition. |
| doi_str_mv | 10.1097/01.CCM.0000266533.06543.0C |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70532569</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70532569</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525C-5b00fbcac322cdd80fcbbaf6e6d5c5ffb123f1e275e22366946f2493e2d374e13</originalsourceid><addsrcrecordid>eNqNkMtu1DAUQC0EokPhF5CFBLtMr-3YabpAqqLykIraBawtx7luTD3JYDuM-ve4nRGzrRd-6J778CHkA4M1g7Y5A7buuh9rKIsrJYVYg5J12bsXZMWkgAp4K16SFUALlahbcULepPQbgNWyEa_JCWtqWRBYkd1tnI3N_i_SrQnBm6erNRGpn2gekW5w8NaE8sw4pf_RZfL5gl45hzYnOk804HSXRzo7mrJ5oG6ONGEoURzo6O_GKvp0X5pkj1NOb8krZ0LCd4fzlPz6cvWz-1Zd33z93l1eV1Zy2VWyB3C9NVZwbofhHJzte-MUqkFa6VzPuHAMeSORc6FUWyvHy4eRD6KpkYlT8mlfdxvnPwumrDc-WQzBTDgvSTcgBZeqLeDFHrRxTimi09voNyY-aAb6UbsGpot2fdSun7Rr6Ery-0OXpS--jqkHzwX4eABMKjJdNJP16cidNy2vxeO4n_fcbg4ZY7oPyw6jHtGEPD5nkn9OcaAQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70532569</pqid></control><display><type>article</type><title>Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Norton, Sally A ; Hogan, Laura A ; Holloway, Robert G ; Temkin-Greener, Helena ; Buckley, Marcia J ; Quill, Timothy E</creator><creatorcontrib>Norton, Sally A ; Hogan, Laura A ; Holloway, Robert G ; Temkin-Greener, Helena ; Buckley, Marcia J ; Quill, Timothy E</creatorcontrib><description>OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU).
DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study.
SETTING:Seventeen-bed adult MICU.
PATIENTS:Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteriaa) intensive care admission following a current hospital stay of ≥10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation.
INTERVENTIONS:Palliative care consultations.
MEASUREMENTS AND MAIN RESULTS:Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge.
CONCLUSIONS:Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000266533.06543.0C</identifier><identifier>PMID: 17452930</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Clinical death. Palliative care. Organ gift and preservation ; Female ; Humans ; Intensive care medicine ; Intensive Care Units - organization & administration ; Length of Stay ; Male ; Medical sciences ; Outcome Assessment (Health Care) - organization & administration ; Palliative Care - organization & administration ; Patient Care Planning - organization & administration ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>Critical care medicine, 2007-06, Vol.35 (6), p.1530-1535</ispartof><rights>2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525C-5b00fbcac322cdd80fcbbaf6e6d5c5ffb123f1e275e22366946f2493e2d374e13</citedby><cites>FETCH-LOGICAL-c525C-5b00fbcac322cdd80fcbbaf6e6d5c5ffb123f1e275e22366946f2493e2d374e13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18792431$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17452930$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Norton, Sally A</creatorcontrib><creatorcontrib>Hogan, Laura A</creatorcontrib><creatorcontrib>Holloway, Robert G</creatorcontrib><creatorcontrib>Temkin-Greener, Helena</creatorcontrib><creatorcontrib>Buckley, Marcia J</creatorcontrib><creatorcontrib>Quill, Timothy E</creatorcontrib><title>Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU).
DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study.
SETTING:Seventeen-bed adult MICU.
PATIENTS:Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteriaa) intensive care admission following a current hospital stay of ≥10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation.
INTERVENTIONS:Palliative care consultations.
MEASUREMENTS AND MAIN RESULTS:Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge.
CONCLUSIONS:Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - organization & administration</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Outcome Assessment (Health Care) - organization & administration</subject><subject>Palliative Care - organization & administration</subject><subject>Patient Care Planning - organization & administration</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMtu1DAUQC0EokPhF5CFBLtMr-3YabpAqqLykIraBawtx7luTD3JYDuM-ve4nRGzrRd-6J778CHkA4M1g7Y5A7buuh9rKIsrJYVYg5J12bsXZMWkgAp4K16SFUALlahbcULepPQbgNWyEa_JCWtqWRBYkd1tnI3N_i_SrQnBm6erNRGpn2gekW5w8NaE8sw4pf_RZfL5gl45hzYnOk804HSXRzo7mrJ5oG6ONGEoURzo6O_GKvp0X5pkj1NOb8krZ0LCd4fzlPz6cvWz-1Zd33z93l1eV1Zy2VWyB3C9NVZwbofhHJzte-MUqkFa6VzPuHAMeSORc6FUWyvHy4eRD6KpkYlT8mlfdxvnPwumrDc-WQzBTDgvSTcgBZeqLeDFHrRxTimi09voNyY-aAb6UbsGpot2fdSun7Rr6Ery-0OXpS--jqkHzwX4eABMKjJdNJP16cidNy2vxeO4n_fcbg4ZY7oPyw6jHtGEPD5nkn9OcaAQ</recordid><startdate>200706</startdate><enddate>200706</enddate><creator>Norton, Sally A</creator><creator>Hogan, Laura A</creator><creator>Holloway, Robert G</creator><creator>Temkin-Greener, Helena</creator><creator>Buckley, Marcia J</creator><creator>Quill, Timothy E</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200706</creationdate><title>Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients</title><author>Norton, Sally A ; Hogan, Laura A ; Holloway, Robert G ; Temkin-Greener, Helena ; Buckley, Marcia J ; Quill, Timothy E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525C-5b00fbcac322cdd80fcbbaf6e6d5c5ffb123f1e275e22366946f2493e2d374e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - organization & administration</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Outcome Assessment (Health Care) - organization & administration</topic><topic>Palliative Care - organization & administration</topic><topic>Patient Care Planning - organization & administration</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Norton, Sally A</creatorcontrib><creatorcontrib>Hogan, Laura A</creatorcontrib><creatorcontrib>Holloway, Robert G</creatorcontrib><creatorcontrib>Temkin-Greener, Helena</creatorcontrib><creatorcontrib>Buckley, Marcia J</creatorcontrib><creatorcontrib>Quill, Timothy E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Norton, Sally A</au><au>Hogan, Laura A</au><au>Holloway, Robert G</au><au>Temkin-Greener, Helena</au><au>Buckley, Marcia J</au><au>Quill, Timothy E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2007-06</date><risdate>2007</risdate><volume>35</volume><issue>6</issue><spage>1530</spage><epage>1535</epage><pages>1530-1535</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU).
DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study.
SETTING:Seventeen-bed adult MICU.
PATIENTS:Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteriaa) intensive care admission following a current hospital stay of ≥10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation.
INTERVENTIONS:Palliative care consultations.
MEASUREMENTS AND MAIN RESULTS:Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge.
CONCLUSIONS:Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>17452930</pmid><doi>10.1097/01.CCM.0000266533.06543.0C</doi><tpages>6</tpages></addata></record> |
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| ispartof | Critical care medicine, 2007-06, Vol.35 (6), p.1530-1535 |
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| subjects | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Clinical death. Palliative care. Organ gift and preservation Female Humans Intensive care medicine Intensive Care Units - organization & administration Length of Stay Male Medical sciences Outcome Assessment (Health Care) - organization & administration Palliative Care - organization & administration Patient Care Planning - organization & administration Prospective Studies Risk Factors Severity of Illness Index Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients |
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