Early Palliative Care in Critically Ill Patients with Fatal Disease is Associated with Decreased Length of Stay

Author(s):

Mark Stice; Quinn Mallery; Mariya Skube; Tatiana Ditta; Greg Beilman

Background:

The care of patients in the intensive care unit (ICU) requires significant resources, especially at the end of life, with sepsis being the major diagnosis in most ICU admissions. Disposition delays, including floor bed availability and end of life decisions are a major cause of prolonged ICU stay. We sought to evaluate the effects of early palliative care (PC) discussions on length of stay (LOS).

Hypothesis:

We hypothesize that early PC consultation is associated with decreased LOS in patients who die in the ICU.

Methods:

Using Crimson (The Advisory Board Co, Washington, DC), a relational quality improvement database, we identified adult patients in 5 ICUs on mechanical ventilation >96 hours during the year 2016 who succumbed to their disease. We compiled two patient groups: those with ICU LOS >10 days over system average, and those with ICU LOS less than system average. Crimson was used to collect patient demographics. Additional retrospective chart review was conducted to assess primary admitting diagnosis, chronic health conditions, and PC intervention practices. Fisher’s exact test and Welch’s test were used to compare groups.

Results:

There were no significant differences in age, sex, chronic illnesses, or illness severity between groups. Sepsis was the most common diagnosis in both groups (43% vs 35%, p= 1, Table 1). Patients with excess LOS received PC consult significantly later in their hospital course (28 vs 10 days, p<0.001, Table 1). In subgroup analysis of septic patients, PC consults occurred significantly later in hospitalization of the excess LOS group (Table 2).

Conclusions:

Early PC intervention in patients who died in the ICU was associated with a significantly shorter LOS. Our study suggests that early PC intervention may decrease unnecessary resource utilization in ICU patients, including those with sepsis as a major diagnosis.