Impact of Critical Care Medicine Training Programs' Palliative Care Education and Bedside Tools on ICU Use at the End of Life

Abstract

Background Intensive care unit (ICU) use at the end of life is rising. Little research has focused on associations among critical care fellows' training, institutional support, and bedside tools with ICU use at the end of life. Objective We evaluated whether hospital and critical care medicine program interventions were associated with ICU use in the last 6 months of life for patients with chronic illness. Methods Our observational, retrospective study explored associations between results from a survey of critical care program directors and hospital-level Medicare data on ICU use in the last 6 months of life. Program directors evaluated quality of palliative care education in their critical care fellowships and reported on the number of bedside tools and the presence or absence of an inpatient palliative care consultation service. Results For the 89 hospitals and 71 affiliated training programs analyzed, there were statistically significant relationships between 2 of the explanatory variables—the quality of palliative care education and the number of bedside tools—in ICU use. Each level of increased educational quality (1–5 Likert scale) was associated with a 0.57-day decrease in ICU days, whereas, for each additional, evidence-based bedside tool, there was a 0.31-day decrease. The presence of an inpatient palliative care program was not a significant predictor of ICU use. Conclusions We found that the quality of palliative care training in critical care medicine programs and the use of bedside tools were independently associated with reduced ICU use at the end of life.

Intensive care unit team perception of palliative care: the discourse of the collective subject

“…Currently, more proactive approaches have been developed to provide PC through educational initiatives among ICU teams, such as tools for bedside communication and symptom management (16) . The current definition of PC indicates an approach that improves the quality of life of patients and families who face life-threatening diseases, via measures to prevent and relieve suffering, early identification and assessment, and impeccable treatment for pain and other physical, psychosocial and spiritual problems (6) .…”

Development of a Standardized Communication Intervention Bundle for Use at a Medical Training Hospital Intensive Care Unit

“…1 Medical house staff receive limited formal training with respect to initiating and structuring the quality of life discussions with patients and their families. 2,3 The GME clinical learning environment review (CLER) program integrates medical education into the tapestry of high quality hospital patient care.…”

Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors

“…A study of pulmonary and critical care fellowship directors provided the concept of surveying PDs via e-mail to assess trainee competence in PC. 34 To establish face and content validity, the survey was piloted among 10 core faculty members in three EM programs in distinct geographical regions who are involved in resident education and familiar with curriculum development and delivery. To maintain the integrity of the final survey to be distributed among PDs/APDs/aPDs, none of the faculty who participated in the pilot survey was surveyed for the final study.…”