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

Autor: Braus N; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Campbell TC; Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Kwekkeboom KL; School of Nursing, University of Wisconsin, Madison, WI, USA., Ferguson S; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Harvey C; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA., Krupp AE; School of Nursing, University of Wisconsin, Madison, WI, USA.; University of Wisconsin Hospital and Clinics, Madison, WI, USA., Lohmeier T; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA., Repplinger MD; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA., Westergaard RP; Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA., Jacobs EA; Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA.; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, USA., Roberts KF; University of Wisconsin Hospital and Clinics, Madison, WI, USA., Ehlenbach WJ; Divisions of Pulmonary and Critical Care Medicine, Allergy and Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 5230 Medical Foundation Centennial Building, 1685 Highland Avenue, mail code 2281, Madison, WI, 53705-2281, USA. wjehlen@medicine.wisc.edu.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2016 Jan; Vol. 42 (1), pp. 54-62. Date of Electronic Publication: 2015 Nov 10.
DOI: 10.1007/s00134-015-4098-1
Abstrakt: 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.
Databáze: MEDLINE
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