Characteristics of palliative care consultation at an academic level one trauma center

Rivet, Emily B.; Ferrada, Paula; Albrecht, Tara; Cassel, J. Brian; Broering, Beth; Noreika, Danielle; Fabbro, Egidio Del

doi:10.1016/j.amjsurg.2017.06.010

Cited by 24 publications

(19 citation statements)

References 8 publications

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“…This is likely explained by palliative care referrals being placed so close to death. Prior studies have shown that patients with palliative care consults are dying in the ICU which supports this observation (24)(25)(26)(27). Propensity score matching was performed to reduce the effect of known confounding variables on outcome.…”

Section: Discussionsupporting

confidence: 61%

Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

Bhulani

Gupta

Gao

et al. 2018

J. Gastrointest. Oncol.

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Section: Discussionsupporting

confidence: 61%

Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

Bhulani

Gupta

Gao

et al. 2018

J. Gastrointest. Oncol.

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“…Compared with a study by Rivet et al that showed tardy PCC implementation resulting in half of their population expiring in ICU or step down units, the high rate of hospice discharge in our PCC group demonstrates the benefits of timely PCC at our two institutions. 24 Our reported mortality rates in the PCC group are higher than the mortality rates of 31.3% and 16.2% in PCC nongeriatric and geriatric trauma patients available from other studies, however, our data also include mortality six months postdischarge. 21 Hwang et al associated PC with decreased use of nonbeneficial life support and lower intensity of care.…”

Section: Discussioncontrasting

confidence: 55%

Reduction in Potentially Inappropriate Interventions in Trauma Patients following a Palliative Care Consultation

Wycech

Fokin

Katz

et al. 2021

Journal of Palliative Medicine

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Background: Palliative care is expanding as part of treatment, but remains underutilized in trauma settings. Palliative care consultations (PCC) have shown to reduce nonbeneficial, potentially inappropriate interventions (PII), as decision for their use should always be made in the context of both the patient's prognosis and the patient's goals of care. Objective: To characterize trauma patients who received PCC and to analyze the effect of PCC and do-notresuscitate (DNR) orders on PII in severely injured patients. Setting/Subjects: Retrospective cohort study of 864 patients admitted to two level 1 trauma centers: 432 patients who received PCC (PCC group) were compared with 432 propensity score match-controlled (MC group) patients who did not receive PCC. Measurements: PCC in a consultative palliative care model, PII (including tracheostomy and percutaneous endoscopic gastrostomy) rate and timing, DNR orders. Results: PCC rate in trauma patients was 4.3%, with a 5.3-day average time to PCC. PII were done in 9.0% of PCC and 6.0% of MC patients ( p = 0.09). In the PCC group, 74.1% of PII were done before PCC, and 25.9% after. PCC compared with MC patients had significantly higher mechanical ventilation (60.4% vs. 18.1%, p < 0.001) and assisted feeding requirements (14.1% vs. 6.7%, p < 0.001). We observed a statistically significant reduction in PII after PCC ( p = 0.002). Significantly less PCC than MC patients had PII following DNR (26.3% vs. 100.0%, p = 0.035). Conclusions: PCC reduced PII in severely injured trauma patients by factor of two. Since the majority of PII in PCC patients occurred before PCC, a more timely administration of PCC is recommended. To streamline goals of care, PCC should supplement or precede a DNR discussion.

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“…Rivet et al from Virginia Commonwealth University performed a retrospective review of 82 patients seen by their palliative service, 50 of which were consulted for comprehensive/end of life issues. 10 Their results mirrored ours, finding that the median time to consultation was 4.5 d and time from consultation to death was 1 d. In this article, trauma surgeons polled suggested that palliative care should be reserved for patients with no remaining treatment options. In our study, 78 patients underwent a therapeutic operation, which we defined as an operation with curative intent, excluding tracheostomy and PEG.…”

Section: Discussionsupporting

confidence: 53%

Goals of Care Discussions for the Imminently Dying Trauma Patient

Bhangu

Young

Posillico

et al. 2020

Journal of Surgical Research

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Background: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. Materials and methods:We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams.Results: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001).Conclusions: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.

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Characteristics of palliative care consultation at an academic level one trauma center

Cited by 24 publications

References 8 publications

Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

Reduction in Potentially Inappropriate Interventions in Trauma Patients following a Palliative Care Consultation

Goals of Care Discussions for the Imminently Dying Trauma Patient

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