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01.01.2016 | Original

Prospective study of a proactive palliative care rounding intervention in a medical ICU

verfasst von: Nicholas Braus, Toby C. Campbell, Kristine L. Kwekkeboom, Susan Ferguson, Carrie Harvey, Anna E. Krupp, Tara Lohmeier, Michael D. Repplinger, Ryan P. Westergaard, Elizabeth A. Jacobs, Kate Ford Roberts, William J. Ehlenbach

Erschienen in: Intensive Care Medicine | Ausgabe 1/2016

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Abstract

Purpose

To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.

Methods

Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients.

Results

One hundred patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63 % higher (RR 1.63, 95 % CI 1.14–2.07, p = 0.01), and time to family meeting was 41 % shorter (95 % CI 52–28 % shorter, p < 0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6 % shorter, 95 % CI 16 % shorter to 4 % longer, p = 0.22). Among those who died in the hospital, ICU LOS was 19 % shorter in the intervention (95 % CI 33–1% shorter, p = 0.043). Adjusted hospital LOS was 26 % shorter (95 % CI 31–20 % shorter, p < 0.001) with the intervention. Post-traumatic stress disorder (PTSD) symptoms were present in 9.1 % of family respondents during the intervention versus 20.7 % prior to the intervention (p = 0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups.

Conclusions

Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.

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Titel: Prospective study of a proactive palliative care rounding intervention in a medical ICU
verfasst von: Nicholas Braus
Toby C. Campbell
Kristine L. Kwekkeboom
Susan Ferguson
Carrie Harvey
Anna E. Krupp
Tara Lohmeier
Michael D. Repplinger
Ryan P. Westergaard
Elizabeth A. Jacobs
Kate Ford Roberts
William J. Ehlenbach
Publikationsdatum: 01.01.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 1/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4098-1

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Prospective study of a proactive palliative care rounding intervention in a medical ICU