Patterns Of Palliative Care Service Consultation In A Sample Of Critically Ill Icu Patients At High Risk Of Dying

Patterns Of Palliative Care Service Consultation In A Sample Of Critically Ill Icu Patients At High Risk Of Dying

Seaman JB; Barnato AE; Sereika SM; Happ MB; Erlen JA

PLOS Neglected Tropical Diseases

2016

Critical Care; End-of-life Care; Palliative Care; Patient-centered Outcomes; Quality Of Health Care

OBJECTIVE: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. BACKGROUND: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. METHODS: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation. RESULTS: About half (773/1440 [54%]) were at high risk of dying or died, 73 (9.4%) of whom received palliative care consultation. On average, referral occurred after 62% of the ICU stay had elapsed. Primary reason for consult was clarification of goals of care (52/73 [72.2%]). CONCLUSIONS: Among MV ICU patients at high risk of dying, palliative care service consultation occurs late and infrequently, suggesting a role for earlier palliative care.

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