scholarly journals Palliative Care Consultation and Effect on Length of Stay in a Tertiary-Level Neurological Intensive Care Unit

2020 ◽  
Vol 1 (1) ◽  
pp. 161-165
Author(s):  
Michael Pottash ◽  
Danielle McCamey ◽  
Hunter Groninger ◽  
Edward F. Aulisi ◽  
Jason J. Chang
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Tertiary Level ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

2019 ◽  
Vol 10 (3) ◽  
pp. 163-167
Author(s):  
Jon Rosenberg ◽  
Allie Massaro ◽  
James Siegler ◽  
Stacey Sloate ◽  
Matthew Mendlik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
High Grade ◽  
Neurological Intensive Care Unit ◽  
Code Status ◽  
Neurological Intensive Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

Outcomes of Patients With Hematologic Malignancies Who Received Inpatient Palliative Care Consultation

2022 ◽  
Author(s):  
Anthony V. Pasquarella ◽  
Shahidul Islam ◽  
Angela Ramdhanny ◽  
Mina Gendy ◽  
Priya Pinto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hematologic Malignancies ◽  
Readmission Rates ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Stepwise Variable Selection ◽  
Palliative Care Consultation

PURPOSE: Palliative care (PC) plays an established role in improving outcomes in patients with solid tumors, yet these services are underutilized in hematologic malignancies (HMs). We reviewed records of hospitalized patients with active HM to determine associations between PC consultation and length of stay, intensive care unit stay, 30-day readmission, and 6-month mortality compared with those who were not seen by PC. METHODS: We reviewed all oncology admissions at our institution between 2013 and 2019 and included patients with HM actively on treatment, stratified by those seen by PC to controls not seen by PC. Groups were compared using Wilcoxon rank-sum, chi-square, and Fisher's exact tests on the basis of the type and distribution of data. Multiple logistic regression models with stepwise variable selection methods were used to find predictors of outcomes. RESULTS: Three thousand six hundred fifty-four admissions were reviewed, among which 370 unique patients with HM were included. Among these, 102 (28%) patients saw PC, whereas the remaining 268 were controls with similar comorbidities. When compared with controls, PC consultation was associated with a statistically significant reduction in 30-day readmissions (16% v 27%; P = .024), increased length of stay (11.5 v 6 days; P < .001), increased intensive care unit admission (28% v 9%; P < .001), and increased 6-month mortality (67% v 15%; P < .001). These data were confirmed in multivariable models. CONCLUSION: In this retrospective study, more than two thirds of patients with HM did not receive PC consultation despite having similar comorbidities, suggesting that inpatient PC consultation is underutilized in patients with HM, despite the potential for decreased readmission rates.

scholarly journals Inventory of a Neurological Intensive Care Unit: Who Is Treated and How Long?

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Roland Backhaus ◽  
Franz Aigner ◽  
Felix Schlachetzki ◽  
Dagmar Steffling ◽  
Wolfgang Jakob ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Invasive Mechanical Ventilation ◽  
Vascular Diseases ◽  
Cerebrovascular Diseases ◽  
Neurological Intensive Care Unit ◽  
Systemic Complications ◽  
Neurological Intensive Care ◽  
Organ Systems

Purpose. To characterize indications, treatment, and length of stay in a stand-alone neurological intensive care unit with focus on comparison between ventilated and nonventilated patient.Methods. We performed a single-center retrospective cohort study of all treated patients in our neurological intensive care unit between October 2006 and December 2008.Results. Overall, 512 patients were treated in the surveyed period, of which 493 could be included in the analysis. Of these, 40.8% had invasive mechanical ventilation and 59.2% had not. Indications in both groups were predominantly cerebrovascular diseases. Length of stay was 16.5 days in mean for ventilated and 3.6 days for nonventilated patient.Conclusion. Most patients, ventilated or not, suffer from vascular diseases with further impairment of other organ systems or systemic complications. Data reflects close relationship and overlap of treatment on nICU with a standardized stroke unit treatment and suggests, regarding increasing therapeutic options, the high impact of acute high-level treatment to reduce consequential complications.

Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. 23-29
Author(s):  
Kim Martz ◽  
Jenny Alderden ◽  
Rick Bassett ◽  
Dawn Swick
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Screening Tool ◽  
Care Delivery ◽  
Screening Tools ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
To Receive

Background Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. Objective To identify outcomes associated with specialty palliative care referral among patients with critical illness. Methods Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. Results Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P &lt; .001). Conclusions Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

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