Variation in Palliative Care Consultation among Severely Injured Patients

Benjenk, Ivy; Prather, Christina; Schockett, Erica; Sarani, Babak; Estroff, Jordan

doi:10.1089/jpm.2019.0053

Cited by 4 publications

(4 citation statements)

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“…6 PCC patients were significantly older, and more often white race than MC patients, which is in line with research from multiple institutions, showing older age and white race as factors associated with a PCC in patients with severe TBI and as factors in end-of-life and PC decisions in trauma patients. 2,22,23 Finally, in the PCC group, 87.7% of patients were discharged to hospice, with a total mortality of 90.7% within six months of discharge, and low in-hospital mortality of <5.0%. 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.…”

Section: Discussionmentioning

confidence: 99%

“…The HLOS matching was important, as it was shown previously that trauma patients with HLOS of more than four days had significantly greater odds of receiving a PCC. 2 The four covariates chosen for propensity matching were thought to most significantly affect the outcome, which was the implementation of a PCC. The matching resulted in two comparable groups that were similar in these four major characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…found a 33.9% rate of palliative care consultations (PCC) in a group of severely injured trauma patients. 2 Hua et al described a 14.7% rate of PCC in trauma/burn intensive care unit (ICU) patients at their institution with a trigger-based model of PC. 3 Clinicians agree that PC implementation improves end-oflife planning, increases patient and family satisfaction, and reduces ICU cost.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…[15][16][17] The primary effective model for palliative care delivery in this setting is an interdisciplinary approach, although there are variations in practice models across the country. 11,[18][19][20] In the USA, advance directives for adults 60 years and older increased from 47% to 72% between 2000 and 2010, and those with living wills were more likely to want limited care or comfort care measures as compared to full care. 21,22 The rates for withdrawal of support in the US have increased over the years with roughly 7% in the 1990s to 50% in the 2000s.…”

Section: Introductionmentioning

confidence: 99%

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

King

Schockett

Rizvi

et al. 2022

J Intensive Care Med

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Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

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Multiple Trauma Management: Treatment of Abdominal Injury in Combination with Trauma Brain Injury

Bartek,

Sonderman,

Salim

2024

Hot Topics in Acute Care Surgery and Trauma

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Variation in Palliative Care Consultation among Severely Injured Patients

Cited by 4 publications

References 1 publication

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

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

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

Multiple Trauma Management: Treatment of Abdominal Injury in Combination with Trauma Brain Injury

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