| Autor: |
Liu K; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Hwang J; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Chesteen K; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Huth H; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Zhu Y; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Mixon A; Vanderbilt University Medical Center, VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC) Tennessee, Nashville, Tennessee, USA., Tillman S; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Misra S; VA Geriatric Research Education and Clinical Center (GRECC) Tennessee, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Karlekar M; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. |
| Abstrakt: |
Background: The COVID-19 pandemic created surges of rapidly deteriorating patients straining health care necessitating the evaluation of novel models of palliative care (PC) integration to reduce patient suffering and hospital strain. Objective: To evaluate an integrated PC model's effect on code status change. Design: This is an observational retrospective study. Setting: Urban quaternary referral center in the southeastern United States from April 6th to August 20th, 2020. Patients: All patients admitted to our medical intensive care unit and stepdown unit were diagnosed with COVID-19. Measurements: Code status change, multivariate regression on patient characteristics. Results: In total, 79.7% (98/123) patients were full code at admission. After PC consultation, 33.3% (41/123) patients remained full code, 13.0% (16/123) were do not resuscitate (DNR), and 53.6% (66/123) changed to DNR/do not intubate (DNI). An ordinal logistic model determined that consultation location (odds ratio [OR] 3.35, p = 0.017) and patient age (OR 1.09, p < 0.001) were predictive of code status change to DNR/DNI. Conclusion: Within an integrated PC model, PC consultation was associated with code status change. The effect of an integrated PC model warrants further study in comparison with a traditional PC model in a similar patient cohort. |
