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

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

Lustbader DR; Pekmezaris R; Frankenthaler M; Walia R; Smith F; Hussain E; Napolitano B; Lesser M

Palliative & Supportive Care

2011

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.

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