Researchers at the University of Rochester Medical Center have found that early palliative care interventions can reduce the length of stay for seriously ill patients in the medical intensive care unit (MICU) by more than seven days without having an impact on mortality rates.
Historically, palliative care was most strongly associated with end-of-life care with palliative care specialists seeing patients very late in their illness -- often after patients had already been in intensive care for two weeks or more or after all other life-prolonging interventions had been exhausted. The Rochester study, published in the June issue of Critical Care Medicine, sought to address this gap by instituting and evaluating the impact of early proactive palliative care consultations on high-risk patients' length of stay in the MICU, length of hospital stay, and mortality.
"One goal of a palliative care consultation is to provide assistance and support to patients and their families while they make health care decisions," said Sally Norton, Ph.D., R.N., assistant professor at the University of Rochester School of Nursing and lead author of the study. "Palliative care consultations are designed to help patients and their families to more fully understand their medical condition, the benefits and burdens of treatments, and likely outcomes to help them make the most informed decisions about the treatments as possible. By earlier identification of patients whose medical treatments are no longer in line with their personal goals we can better alleviate their pain, manage symptoms, and get them into an environment they prefer, thereby improving their overall quality of life."
The study looked at the impact of palliative care interventions on all 191 patients admitted to the MICU at Strong Memorial Hospital in Rochester, NY, between March 2004 and March 2005 identified as having a serious illness and at high risk of dying. The patients were screened by physician and nursing palliative care leaders within 72 hours of admission.
Patients admitted during first phase of the study received a palliative care consultation only after a MICU physician referral as was the standard practice prior to the study. High-risk patients admitted during the second phase received a proactive palliative care consultation shortly after admission. The study found that patients in the proactive phase had significantly shorter lengths of stay in the MICU than those in the first phase, while there was no difference between the two groups on total length of stay in the hospital or mortality rates.
"Palliative care is not about giving up on the most aggressive treatment," said Timothy Quill, M.D., director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center and co-author of the study. "It's about empowering the sickest and most vulnerable patients and their families with the tools and information they need to do what they feel is best. Early palliative care interventions are a value-added service we can provide to these individuals and their families, and improve care in the MICU setting."
In addition to improving quality of care, proactive palliative care consultation in the MICU has an unintended, yet relevant, benefit of financial savings. Extrapolating from the study's findings, the intervention potentially saved approximately 1,400 MICU patient days at a savings of around $450 per day. In a hospital like Strong where the MICU regularly operates at 100-percent capacity, such an improvement in efficiency frees beds for patients in the emergency department and elsewhere who are in need of critical care. Recognizing and demonstrating these indirect financial effects is critical to ensuring palliative care consultation services continue to expand in hospital settings nationwide.
In addition to Norton and Quill, authors of the study included Laura Hogan, M.S., R.N., Robert Holloway, M.D., M.P.H., and Marcia Buckley, M.S., R.N., from the Center for Ethics Humanities and Palliative Care; and Helena Temkin-Greener, Ph.D., M.P.H. from the Department of Community and Preventive Medicine. The study was funded, in part, by the Fraser-Parker Foundation in Atlanta, Ga.
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