Impact of Proactive Palliative Medicine in the Intensive Care Unit at a Community Teaching Hospital
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III. Conclusion. Often the goal in acute illness is aggressive treatment or extensive diagnostic eval- uation and palliative care goals may be perceived as conflicting. This case report illustrates the poor outcomes that can result if goals of care are not clearly elucidated but also an opportu- nity to upstream palliative care. Domain Structure and Processes of Care Impact of Proactive Palliative Medicine in the Intensive Care Unit at a Community Teaching Hospital Kathryn Walker, PharmD BCPS CPE, University of Maryland School of Pharmacy, Baltimore, MD. Tanya Telegadis, PharmD, University of Mary- land School of Pharmacy, Baltimore, MD. Heon Soo Yi, MS, University of Maryland School of Medicine, Baltimore, MD. Rene Mayo, LSWA, Union Memorial Hospital, Baltimore, MD. Sarah Bayne, FNP, Union Memorial Hospi- tal, Baltimore, MD. Christopher Kearney, MD, Union Memorial Hospital, Baltimore, MD. (All speakers have disclosed no relevant finan- cial relationships.) Objectives 1. Describe the screening process for proactive palliative medicine consultation. 2. Discuss the impact of this study on time to pal- liative medicine consult. 3. Discuss the impact of this study on ICU and hospital length of stay. I. Background. Union Memorial Hospital (UMH) is community teaching hospital with an interdis- ciplinary palliative medicine (PM) consult team (physician, social worker, nurse practitioner, and clinical pharmacist). The intensive care unit (ICU) is a 25-bed, mixed medical-surgical unit. Previous UMH data indicated PM medical intensive care unit (MICU) consults occurred at average inhospital day 9. Screening criteria was developed to identify patients for earlier in- volvement. The purpose of this study was to eval- uate the impact of the screening criteria on time to consult, consult volume, length of stay (LOS) outcomes and costs. II. Research Objectives. (i) Measure impact of patients receiving a PM consult compared to patients meet- ing PM screening criteria without consultation; and (ii) compare cost-savings between groups. III. Methods. All MICU patients were screened twice weekly using the established criteria from November 2008eJune 2009. The MICU attend- ing physician was notified of patients screening positive. A retrospective chart review was con- ducted to compare patients receiving PM con- sults to patients screening positive without PM consults. Data collection included demograph- ics, LOS, and costs. IV. Results. There were 52 PM consults and 73 patients in the control group. The PM group was older (70 vs. 61 years), but the groups were similar for other demographics and severity of illness scores. Both groups met a median of one criterion. The LOS was shorter in the PM consult group compared to controls for both the hospital (14.8 vs. 20.3) and MICU LOS (10.8 vs. 14.4). On average, the PM consult oc- curred on ICU day 5.6. PM consults showed cost-savings compared to controls. V. Conclusion. Proactive screening in the MICU was associated with earlier intervention, decreased MICU and hospital LOS, and decreased costs. VI. Implications for Research, Policy, or Practice. Pal- liative medicine involvement in the ICU serves an important role in avoiding unnecessary inter- ventions and facilitating appropriate levels of care at end-of-life. This can greatly impact costs and associated burden to the patient, family, in- stitution, and society. Domain Structure and Processes of Care Impact of a Communication Intervention Around Goals of Care on Racial Disparities in End-of-Life Care in the Intensive Care Unit Anne Mosenthal, MD, New Jersey Medical School, Newark, NJ. Patricia Murphy, PhD APN FAAN, UMDNJ University Hospital, Livingston, NJ. Sangeeta Lamba, MD, UMDNJ New Jersey Medical School, Newark, NJ. Scott Compton, PhD, UMDNJ New Jersey Medical School, New- ark, NJ. Jessica Zitter, MD MPH, Vital Decisions, Millburn, NJ. (All speakers have disclosed no relevant finan- cial relationships with the following exceptions: Zitter is a shareholder at Vital Decisions, LLC.) Objectives 1. Discuss racial differences in preferences and outcomes in end-of-life care in the ICU. 2. Describe communication interventions for goals of care discussions that are effective in the ICU setting in the African American population. 342 Schedule with Abstracts Vol. 39 No. 2 February 2010
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Transcript of Impact of Proactive Palliative Medicine in the Intensive Care Unit at a Community Teaching Hospital
342 Schedule with Abstracts Vol. 39 No. 2 February 2010
III. Conclusion. Often the goal in acute illness isaggressive treatment or extensive diagnostic eval-uation and palliative care goals may be perceivedas conflicting. This case report illustrates thepoor outcomes that can result if goals of careare not clearly elucidated but also an opportu-nity to upstream palliative care.
DomainStructure and Processes of Care
Impact of Proactive Palliative Medicine inthe Intensive Care Unit at a CommunityTeaching HospitalKathryn Walker, PharmD BCPS CPE, University ofMaryland School of Pharmacy, Baltimore, MD.Tanya Telegadis, PharmD, University of Mary-land School of Pharmacy, Baltimore, MD.Heon Soo Yi, MS, University of Maryland Schoolof Medicine, Baltimore, MD. Rene Mayo,LSWA, Union Memorial Hospital, Baltimore,MD. Sarah Bayne, FNP, Union Memorial Hospi-tal, Baltimore, MD. Christopher Kearney,MD, Union Memorial Hospital, Baltimore, MD.(All speakers have disclosed no relevant finan-cial relationships.)
Objectives1. Describe the screening process for proactive
palliative medicine consultation.2. Discuss the impact of this study on time to pal-
liative medicine consult.3. Discuss the impact of this study on ICU and
hospital length of stay.
I. Background. Union Memorial Hospital (UMH)is community teaching hospital with an interdis-ciplinary palliative medicine (PM) consult team(physician, social worker, nurse practitioner,and clinical pharmacist). The intensive careunit (ICU) is a 25-bed, mixed medical-surgicalunit. Previous UMH data indicated PM medicalintensive care unit (MICU) consults occurredat average inhospital day 9. Screening criteriawas developed to identify patients for earlier in-volvement. The purpose of this study was to eval-uate the impact of the screening criteria on timeto consult, consult volume, length of stay (LOS)outcomes and costs.II. Research Objectives. (i) Measure impactof patientsreceiving a PM consult compared to patients meet-ing PM screening criteria without consultation;and (ii) compare cost-savings between groups.III. Methods. All MICU patients were screenedtwice weekly using the established criteria from
November 2008eJune 2009. The MICU attend-ing physician was notified of patients screeningpositive. A retrospective chart review was con-ducted to compare patients receiving PM con-sults to patients screening positive without PMconsults. Data collection included demograph-ics, LOS, and costs.IV. Results. There were 52 PM consults and 73patients in the control group. The PM groupwas older (70 vs. 61 years), but the groups weresimilar for other demographics and severity ofillness scores. Both groups met a median ofone criterion. The LOS was shorter in the PMconsult group compared to controls for boththe hospital (14.8 vs. 20.3) and MICU LOS(10.8 vs. 14.4). On average, the PM consult oc-curred on ICU day 5.6. PM consults showedcost-savings compared to controls.V. Conclusion. Proactive screening in the MICU wasassociated with earlier intervention, decreasedMICU and hospital LOS, and decreased costs.VI. Implications for Research, Policy, or Practice. Pal-liative medicine involvement in the ICU servesan important role in avoiding unnecessary inter-ventions and facilitating appropriate levels ofcare at end-of-life. This can greatly impact costsand associated burden to the patient, family, in-stitution, and society.
DomainStructure and Processes of Care
Impact of a Communication InterventionAround Goals of Care on Racial Disparitiesin End-of-Life Care in the Intensive CareUnitAnne Mosenthal, MD, New Jersey MedicalSchool, Newark, NJ. Patricia Murphy, PhD APNFAAN, UMDNJ University Hospital, Livingston,NJ. Sangeeta Lamba, MD, UMDNJ New JerseyMedical School, Newark, NJ. Scott Compton,PhD, UMDNJ New Jersey Medical School, New-ark, NJ. Jessica Zitter, MD MPH, Vital Decisions,Millburn, NJ.(All speakers have disclosed no relevant finan-cial relationships with the following exceptions:Zitter is a shareholder at Vital Decisions, LLC.)
Objectives1. Discuss racial differences in preferences and
outcomes in end-of-life care in the ICU.2. Describe communication interventions for
goals of care discussions that are effective inthe ICU setting in the African Americanpopulation.
