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Palliative Care and End of Life Issues |

Integrating Palliative Care Into Critical Care Medicine: An Observational Study

Cynthia Kim*, MD; Shirish Amrutia, MD; Tara Friedman, MD; James Gasperino, MD
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Drexel University College of Medicine, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):758A. doi:10.1378/chest.1381549
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Abstract

SESSION TYPE: End of Life Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Although many patients with terminal illnesses experience an escalating intensity of medical care at the end of life, this escalation is frequently not consistent with their preferences. In July 2010, palliative care consultation (PCC) became available to meet the needs of these patients and their families in our medical intensive care unit (ICU). We hypothesize that significant differences in clinical and economic outcomes exist between patients admitted to the ICU who received PCC and those who did not.

METHODS: We performed a retrospective review of medical records from July 2010 to October 2010 and identified 41 patients admitted to the ICU who received PCC and 80 randomly selected patients who did not. We measured a number of clinical outcomes and economic variables associated with their ICU course.

RESULTS: On average, the palliative care group (PCG) was older (64yrs vs. 55.6yrs, p = 0.008) and sicker (Apache IV score 85.5 vs. 60, p < 0.001) than their non-PCG critically ill counterparts. The PCG received significantly more total days of ICU care (13d vs. 5.79d, p = 0.003), had more ICU admissions, and were more likely to die during the ICU stay (64.3% vs. 12.3%, p < 0.001). Average total hospital charges per patient attributable to ICU care were higher in the PCG relative to the control group ($385,700 vs. $209,500, p = 0.001). After adjusting for ICU LOS, ICU charges per day per patient did not differ significantly between groups ($57,517 vs. $62,143, p = 0.734). The average time to palliative care consultation during the ICU stay was 10.7 days.

CONCLUSIONS: Patients who received PCC represented a unique population with higher disease acuity, longer ICU LOS, and higher ICU mortality than their non-PCG counterparts. Clinical outcomes in the PCG remained poor despite dedicating substantial ICU resources.

CLINICAL IMPLICATIONS: Targeted PC “trigger” programs in the ICU may lead to reductions in invasive, often futile care and increase patient comfort at the end of life.

DISCLOSURE: The following authors have nothing to disclose: Cynthia Kim, Shirish Amrutia, Tara Friedman, James Gasperino

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Drexel University College of Medicine, Philadelphia, PA

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