Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T08:16:58.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients

Published online by Cambridge University Press:  22 November 2011

Dana Lustbader ,
Renee Pekmezaris ,
Michael Frankenthaler ,
Rajni Walia ,
Frederick Smith ,
Erfan Hussain ,
Barbara Napolitano  and
Martin Lesser
Dana Lustbader*
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Renee Pekmezaris
Affiliation:
North Shore-LIJ Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York The Feinstein Institute for Medical Research, Manhasset, New York
Michael Frankenthaler
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Rajni Walia
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Frederick Smith
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Erfan Hussain
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Barbara Napolitano
Affiliation:
North Shore-LIJ Health System, Great Neck, New York The Feinstein Institute for Medical Research, Manhasset, New York
Martin Lesser
Affiliation:
North Shore-LIJ Health System, Great Neck, New York The Feinstein Institute for Medical Research, Manhasset, New York
*
Address correspondence and reprint requests to: Dana Lustbader, 300 Community Drive, Manhasset, NY 11030. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.

Method:

A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.

Results:

Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2 test, p < 0.0001).

Significance of results:

Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.

Keywords

Medical intensive carePalliative medicine consultationDo not resuscitateAcute physiology and chronic health evaluation
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 4 , December 2011 , pp. 401 - 406
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Angus, D.C., Barnato, A.E., Linde-Zwirble, W.T., et al. (2004). Use of intensive care at the end o life in the United States: An epidemiologic study. Critical Care Medicine, 32, 638–643.CrossRefGoogle Scholar
Campbell, M.L. (2006). Palliative care consultation in the intensive care unit. Critical Care Medicine, 34, S355–S358.CrossRefGoogle ScholarPubMed
Campbell, M.L. & Guzman, J.A. (2003). Impact of a proactive approach to improve end of life care in the medical ICU. Chest, 123, 266–271.CrossRefGoogle ScholarPubMed
Cook, D., Rocker, G., Marshal, J., et al. (2003). Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. The New England Journal of Medicine, 349, 1123–1132.CrossRefGoogle ScholarPubMed
Efron, B. & Tibshirani, R.J. (1994). An Introduction to the Bootstrap. New York: Chapman and Hall,CrossRefGoogle Scholar
Elprern, E.H., Covert, B. & Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care, 14, 523–530.CrossRefGoogle Scholar
Gruenberg, D.A., Shelton, W., Rose, S.L., et al. (2006). Factors influencing length of stay in the intensive care unit. American Journal of Critical Care, 15, 502–509.CrossRefGoogle ScholarPubMed
Keating, N.L., Landrum, M.B., Rogers, S.O., et al. (2010). Physician factors associated with discussions about end of life care. Cancer, 116, 998–1006.CrossRefGoogle ScholarPubMed
Landry, F.J., Parker, J.M. & Phillips, Y.Y. (1992). Outcome of cardiopulmonary resuscitation in the intensive care setting. Archives of Internal Medicine, 152, 2305–2308.CrossRefGoogle ScholarPubMed
Lautrette, A., Darmon, M., Megarbane, B., et al. (2007). A communication strategy and brochure for relatives of patients dying in the ICU. The New England Journal of Medicine, 356, 469–78.CrossRefGoogle ScholarPubMed
Mularski, R.A., Heine, C.E., Osborne, M.L., et al. (2005). Quality of dying in the ICU: Ratings by family members. Chest, 128, 280–287.CrossRefGoogle ScholarPubMed
Schultz, S.C., Cullinane, D.C., Pasquale, M.D., et al. (1996). Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation, 33, 13–17.CrossRefGoogle ScholarPubMed
Selecky, P., Eliassaon, A.H., Hall, R.I., et al. (2005). Palliative and end of life care for patients with cardiopulmonary diseases. The American College of Chest Physicians Position Statement. Chest, 128, 3599–3610.CrossRefGoogle ScholarPubMed
The Society of Critical Care Medicine Ethics Committee (1992). Attitudes of critical care medicine professionals concerning forgoing life-sustaining treatments. Critical Care Medicine, 20, 320–326.CrossRefGoogle Scholar
The SUPPORT Principal Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The Journal of the American Medical Association, 274, 1591–1598.CrossRefGoogle Scholar
Thelen, M. (2005). End of life decision making in intensive care. Critical Care Nurse, 25, 28–37.CrossRefGoogle ScholarPubMed