Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit

Abstract

Background: Little is known about the characteristics of patients needing palliative care consultation in the emergency department (ED). This study aimed to investigate the impacts of initiating screening in acute critically ill patients needing palliative care on mortality, health care resources, and end-of-life (EOL) care in the intensive care unit in ED (EICU). Methods: We conducted an analysis study in Taipei Veterans General Hospital. From February 1 to July 31, 2018, acute critically ill patients in EICU were recruited. The primary outcomes were inhospital mortality and EOL care. The secondary outcomes included clinical characteristics and health care utilization. Results: A total of 796 patients were screened, with 396 eligible and 400 noneligible patients needing palliative care consultations. The mean age was 74.8 ± 17.1 years, and 62.6% of the patients were male. According to logistic regression analysis, clinical predictors, including age (adjusted odds ratio [AOR], 1.028; 95% CI, 1.015-1.042), respiratory distress and/or respiratory failure (AOR, 2.670; 95% CI, 1.829-3.897), the Acute Physiology and Chronic Health Evaluation II score (AOR, 1.036; 95% CI, 1.009-1.064), Charlson Comorbidity Index score (AOR, 1.212; 95% CI, 1.125-1.306), and Glasgow Coma Scale (AOR, 0.843; 95% CI, 0.802-0.885), were statistically more significant in eligible patients than in noneligible patients. The inhospital mortality rate was significantly higher in eligible patients than that in noneligible patients (40.7% vs 11.5%, p < 0.01). Eligible patients have a higher ratio in both vasopressor and narcotic use and withdrawal of endotracheal tube than noneligible patients (p < 0.05). Conclusion: Our study results demonstrated that initiating palliative consultation for acute critically ill patients in ED had an impact on the utilization of health care resources and quality of EOL care. Further assessments of the viewpoints of ED patients and their family on palliative care consultations and hospice care are required.

General Characteristics of Palliative Care Patients Admitted to the Emergency Department

“…In some studies performed on palliative care patients, it has been reported that the duration of stay in emergency services varies between 3.5-16 hours. 18,[20][21][22] In our study, it was determined that the mean duration of stay in EDs was 9.97 hours.…”

Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study

“…Previous studies suggest that functional status is also a strong predictor for mortality rate [ 46 , 47 ]. Functional status has been integrated as a part of the screening criteria of the palliative care tool we used in this study [ 20 ], which allowed us to limit all patients’ functional status to a certain degree. However, future studies may consider functional status as another independent predictor when assessing palliative care needs.…”

“…Patients were categorized into three end-of-life trajectories (terminal cancer, organ failure, and frailty) according to their main illness using a screening tool established beforehand [ 20 ]. In the present study, we used the criteria defined by the screening tool.…”

“…Eligibility was assessed with the screening tool developed by George et al [ 21 ] and further modified by Yang et al [ 20 ]. The screening tool contained 15 items, 9 of which assessed the presence of an acute severe life-limiting illness, and 6 of which assessed unmet palliative care needs.…”

Differences in Characteristics, Hospital Care and Outcomes between Acute Critically Ill Emergency Department Patients with Early and Late Do-Not-Resuscitate Orders

“…Utilization criteria were formulated by palliative care (PC) and hospice specialists and adopted to identify patients at high risk of poor clinical outcomes as their care commonly involves prolonged use of advanced medical resources or technologies [10]. Two trained authors entered the abstracted data for study analyses.…”