The triad that matters: palliative medicine, code status, and health care costs.
Female; Humans; Male; Aged; Middle Aged; Equipment and Supplies; hospice; Patient Admission; Emergency Service; 80 and over; retrospective studies; DNAR; DNAR Outcomes; Surgical Procedures; Critical Illness/ep [Epidemiology]; Palliative Care/ut [Utilization]; Critical Illness/ec [Economics]; Emergency Service; Hospital Costs/sn [Statistics & Numerical Data]; Intensive Care/ec [Economics]; Length of Stay/ec [Economics]; Palliative Care/ec [Economics]; Code status; Direct Service Costs/sn [Statistics & Numerical Data]; health care cost; Hospital/ec [Economics]; Hospital/ut [Utilization]; Intensive Care/ut [Utilization]; Laboratories; Length of Stay/sn [Statistics & Numerical Data]; Operative/ec [Economics]; palliation; Radiology Department; Respiratory Care Units/ec [Economics]; United States/ep [Epidemiology]
INTRODUCTION: Delayed discussion of a patient's code status can lead to shortsighted care plans that increase hospital length of stay (LOS) and costs., METHODS: Retrospective study compared intensive care unit (ICU) patients who accepted verses rejected palliation and examined the relationships between 5 predictor variables with the outcome variables ICU LOS and total hospital LOS, and total direct and variable hospital cost., RESULTS: A significant number of patients who accepted palliative care agreed to a hospice referral or expired in the hospital. The relationships between days until a family conference, do-not-resuscitate (DNR) order, and the number of invasive procedures were significant., CONCLUSIONS: The amount of time that expires until the issue of code status was settled to clearly related to utilization of hospital resources.
2010
Celso BG; Meenrajan S
The American Journal Of Hospice & Palliative Care
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/1049909110363806" target="_blank" rel="noreferrer">10.1177/1049909110363806</a>
Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients.
Female; Humans; Male; Medical Futility; Aged; referral and consultation; Costs and Cost Analysis; retrospective studies; DNAR; Resuscitation Orders; Palliative Care; DNAR Outcomes; APACHE; Hospital Mortality/td [Trends]; Intensive Care Units/statistics & numerical data; Length of Stay/sn [Statistics & Numerical Data]; Acute physiology and chronic health evaluation; Do not resuscitate; Length of Stay/td [Trends]; Medical intensive care; Palliative medicine consultation
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%, chi2 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.
Lustbader DR; Pekmezaris R; Frankenthaler M; Walia R; Smith F; Hussain E; Napolitano B; Lesser M
Palliative & Supportive Care
2011
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1017/s1478951511000423" target="_blank" rel="noreferrer">10.1017/s1478951511000423</a>