Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-18T17:54:51.070Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients

Published online by Cambridge University Press:  22 November 2011

Glen Digwood ,
Dana Lustbader ,
Renee Pekmezaris ,
Martin L. Lesser ,
Rajni Walia ,
Michael Frankenthaler  and
Erfan Hussain
Glen Digwood
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Dana Lustbader
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Renee Pekmezaris*
Affiliation:
North Shore–LIJ Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York The Feinstein Institute for Medical Research, Manhasset, New York Hofstra University School of Medicine, Hempstead, New York
Martin L. Lesser
Affiliation:
North Shore–LIJ Health System, Great Neck, New York The Feinstein Institute for Medical Research, Manhasset, New York Hofstra University School of Medicine, Hempstead, New York
Rajni Walia
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Michael Frankenthaler
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Erfan Hussain
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, 175 Community Drive, Great Neck, NY 11021. E-mail: rpekmeza@nshs.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This study evaluates the impact of a 10-bed inpatient palliative care unit (PCU) on medical intensive care unit (MICU) mortality and length of stay (LOS) for terminally ill patients following the opening of an inpatient PCU. We hypothesized that MICU mortality and LOS would be reduced through the creation of a more appropriate location of care for critically ill MICU patients who were dying.

Method: We performed a retrospective electronic database review of all MICU discharges from January 1, 2006 through December 31, 2009 (5,035 cases). Data collected included MICU mortality, MICU LOS, and mean age. The PCU opened on January 1, 2008. We compared location of death for MICU patients during the 2-year period before and the 2-year period after the opening of the PCU.

Results: Our data showed that the mean MICU mortality and MICU LOS both significantly decreased following the opening of the PCU, from 21 to 15.8% (p = 0.003), and from 4.6 to 4.0 days (p = 0.014), respectively.

Significance of results: The creation of an inpatient PCU resulted in a statistically significant reduction in both MICU mortality rate and MICU LOS, as terminally ill patients were transitioned out of the MICU to the PCU for end-of-life care. Our data support the hypothesis that a dedicated inpatient PCU, capable of providing care to patients requiring mechanical ventilation or vasoactive agents, can protect terminally ill patients from an ICU death, while providing more appropriate care to dying patients and their loved ones.

Keywords

Palliative care unitLength of stayMortality rate
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 4 , December 2011 , pp. 387 - 392
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Azoulay, E.,Pochard, F.,Kentish–Barnes, N., et al. (2005). Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 171, 987–994.Google Scholar
Bradley, C.T. & Brasel, K.J. (2009). Developing guidelines that identify patients who would benefit from palliative care services in the surgical intensive care unit. Critical Care Medicine, 37, 946–950.CrossRefGoogle ScholarPubMed
Campbell, M.L. & Guzman, J.A. (2003). Impact of a proactive approach to improve end of life care in the medical ICU. Chest, 123, 266–271.Google Scholar
Gelinas, C. (2007). Management of pain in cardiac surgery ICU patients: Have we improved over time? Intensive and Critical Care Nursing, 23, 298–303.Google Scholar
Goodman, D.C., Esty, A.R., Fisher, E.S., et al. (2011). Trends and variation in end of life care for Medicare beneficiaries with severe chronic illness. The Dartmouth Institute for Health Policy and Clinical Practice. Available at: http://www.dartmouthatlas.org/downloads/reports/EOL_Trend_Report_0411.pdf. Accessed October 11, 2011.Google Scholar
Goodman, D.C., Fisher, E.S., Chang, C.H., et al. (2010). Quality of end-of-life cancer care for Medicare beneficiaries regional and hospital-specific analyses. The Darmouth Institute for Health Policy and Clinical Practice, 1–52. Available at: http://www.dartmouthatlas.org/downloads/reports/Cancer_report_11_16_10.pdf. Accessed October 11, 2011.Google ScholarPubMed
Hanson, L.C., Usher, B., Spragens, L., et al. (2008). Clinical and economic impact of palliative care consultation. Journal of Pain and Symptom Management, 35, 340–346.CrossRefGoogle ScholarPubMed
Morrison, R.S., Penrod, J.D., Cassel, J.B., et al. (2008). Cost savings associated with US hospital palliative care consultation programs. Archives of Internal Medicine, 168 (16), 1783–1790.Google Scholar
Nelson, J.E. (2006). Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit. Critical Care Medicine, 34, S324–S331.CrossRefGoogle ScholarPubMed
Pochard, F., Azoulay, E., Chevret, S., et al. (2001). French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Critical Care Medicine, 29, 1893–1897.CrossRefGoogle ScholarPubMed
Prendergast, T.J. & Luce, J.M. (1997). Increasing incidence of withholding and withdrawal of life support from the critically ill. American Journal of Respiratory Critical Care Medicine, 155, 15–20.CrossRefGoogle ScholarPubMed
Smith, T., Coyne, P., Cassel, B., et al. (2003). A high-volume specialist palliative care unit and team may reduce in-hospital end of life care costs. Journal of Palliative Medicine, 6, 699–705.Google Scholar
The SUPPORT Principal Investigators (1995). A Controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). Journal of the American Medical Association, 274, 1591–1598.CrossRefGoogle Scholar
Teno, J.M., Clarridge, B.R., Casey, V., et al. (2004). Family perspectives on end of life care at the last place of care. Journal of the American Medical Association, 291, 88–93.CrossRefGoogle ScholarPubMed
Zar, J.H. (1984). Biostatistical Analysis, 2nd ed. Englewood Cliffs: Prentice Hall.Google Scholar