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

Title

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

Creator

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

Publisher

Palliative & Supportive Care

Date

2011

Subject

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

Description

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.

Rights

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).

Type

Journal Article

Citation List Month

Backlog

Pages

401-6

Issue

4

Volume

9

Citation

Lustbader DR; Pekmezaris R; Frankenthaler M; Walia R; Smith F; Hussain E; Napolitano B; Lesser M, “Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients.,” Pediatric Palliative Care Library, accessed October 16, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11574.

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