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Evaluation of screening criteria for palliative care consultation in the MICU: a multihospital analysis
  1. Robert Zalenski1,
  2. Cheryl Courage1,
  3. Alexandra Edelen1,
  4. Denise Waselewsky1,
  5. Hicham Krayem2,
  6. Jordana Latozas2 and
  7. David Kaufman3
  1. 1Department of Emergency Medicine, Division of Palliative Care, Wayne State University School of Medicine, Detroit, Michigan, USA
  2. 2Detroit Medical Center, Detroit, Michigan, USA
  3. 3Critical Care Services, Vanguard Health Systems, Nashville, Tennessee, USA
  1. Correspondence to Cheryl Courage, Emergency Medicine, Wayne State University, 6071 W. Outer Drive, L436, Detroit, MI 48235, USA; ccourage{at}med.wayne.edu

Abstract

Background There are currently no comprehensive studies in critical care settings that have set out to examine the association of palliative care screening criteria with multiple, adverse patient outcomes.

Methods A 7-item palliative care screen was developed from consensus reports. Medical intensive care unit (MICU) nurses at four hospitals screened patients upon admission during a 16-week period. Outcomes included percentage of patients screened and their percentage with consultations ordered. Patient screen scores were compared with mortality, hospice discharge and length of stay (LOS).

Results During the period, 1071 patients were admitted to MICUs, of which, 59.3% were screened; 35.3% of patients screened positive. Patients with positive screens (n=225) were more likely to have a consult ordered (33.6% vs 3.4%; p<0.001), and likelihood of consult increased with higher screen scores. Patients with positive screens had significantly longer hospital and MICU LOS (p<0.001), and had increased risk of inpatient mortality (p<0.001) and hospice discharge (p<0.001). Criteria of ‘admission from a skilled nursing facility’ and ‘readmission to the ICU’ were significant predictors of LOS; ‘cancer,’ ‘post cardiac arrest,’ and ‘team perceived need’ were predictors of the composite variable of mortality/hospice discharge. ‘End-stage dementia’ and ‘intracranial bleed’ were not predictive of adverse outcomes.

Conclusions Decisions on the appropriateness for palliative care consultation in the MICU can be aided using a trigger screen. We recommend the use of this screen be considered in the MICU with the suggested revisions. Additional studies are needed to determine if the use of the trigger screen is associated with improved clinical outcomes.

  • Palliative Care
  • Critical Care
  • Screening
  • Clinical Outcomes Research
  • Quality Improvement

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