Medline ® Abstract for Reference 19
of 'Palliative care: Issues in the intensive care unit in adults'
Prospective study of a proactive palliative care rounding intervention in a medical ICU.
Braus N, Campbell TC, Kwekkeboom KL, Ferguson S, Harvey C, Krupp AE, Lohmeier T, Repplinger MD, Westergaard RP, Jacobs EA, Roberts KF, Ehlenbach WJ
Intensive Care Med. 2016 Jan;42(1):54-62. Epub 2015 Nov 10.
PURPOSE: To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.
METHODS: Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients.
RESULTS: One hundred patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63 % higher (RR 1.63, 95 % CI 1.14-2.07, p = 0.01), and time to family meeting was 41 % shorter (95 % CI 52-28 % shorter, p < 0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6 % shorter, 95 % CI 16 % shorter to 4 % longer, p = 0.22). Among thosewho died in the hospital, ICU LOS was 19 % shorter in the intervention (95 % CI 33-1% shorter, p = 0.043). Adjusted hospital LOS was 26 % shorter (95 % CI 31-20 % shorter, p < 0.001) with the intervention. Post-traumatic stress disorder (PTSD) symptoms were present in 9.1 % of family respondents during the intervention versus 20.7 % prior to the intervention (p = 0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups.
CONCLUSIONS: Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.