Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization
| Autor: | Tyler M Smith, Patrick Duffy, Heather Carmichael, Arek J Wiktor, Hareklia Brackett, Margaret Dines, Sarah E Mather, Maurice C Scott, Anne Lambert Wagner |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Quality management Palliative care Critical Care medicine.medical_treatment Burn Units Population Psychological intervention Humans Medicine Cardiopulmonary resuscitation education Aged Retrospective Studies Retrospective review education.field_of_study business.industry Palliative Care Rehabilitation Burn center Length of Stay Middle Aged Quality Improvement Intensive Care Units Emergency medicine Emergency Medicine Female Surgery Burns business |
| Zdroj: | Journal of Burn Care & Research. 42:1128-1135 |
| ISSN: | 1559-0488 1559-047X |
| DOI: | 10.1093/jbcr/irab140 |
| Popis: | Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a 4-year period. The use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments), and do not attempt resuscitation (DNAR) orders were determined. The use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (24 hours, 67% (n = 14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs 36% of these patients having PCC before death (P = .004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC. |
| Databáze: | OpenAIRE |
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