Palliative and Supportive Care

Original Articles

Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients

Dana Lustbadera1 c1, Renee Pekmezarisa1a2a3, Michael Frankenthalera1, Rajni Waliaa1, Frederick Smitha1, Erfan Hussaina1, Barbara Napolitanoa1a3 and Martin Lessera1a3

a1 North Shore-LIJ Health System, Great Neck, New York

a2 Albert Einstein College of Medicine, Bronx, New York

a3 The Feinstein Institute for Medical Research, Manhasset, New York

Abstract

Objective: The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.

Method: A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.

Results: Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2 test, p < 0.0001).

Significance of results: Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.

(Received March 09 2009)

(Accepted September 10 2010)

Correspondence:

c1 Address correspondence and reprint requests to: Dana Lustbader, 300 Community Drive, Manhasset, NY 11030. E-mail: lustbader@nsuh.edu