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The relationship between the timing of a palliative care consult and utilization outcomes for ventilator-assisted intensive care unit patients

Published online by Cambridge University Press:  29 October 2013

Salonie Pereira ,
Andrzej Kozikowski ,
Renee Pekmezaris ,
Suzanne Sunday ,
Tanveer Mir ,
Maha Saad ,
Lauren Corrado  and
Gisele Wolf-Klein
Salonie Pereira
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Andrzej Kozikowski*
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York
Renee Pekmezaris
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Suzanne Sunday
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Feinstein Institute for Medical Research, Manhasset, New York
Tanveer Mir
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Maha Saad
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York St John's University College of Pharmacy and Health Sciences, Queens, New York Long Island Jewish Medical Center, New Hyde Park, New York
Lauren Corrado
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Gisele Wolf-Klein
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Andrzej Kozikowski, North Shore–Long Island Jewish Health System, 175 Community Drive, Second Floor, Great Neck, New York 11021. E-mail: akozikowski@nshs.edu
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Abstract

Objective:

Given the great number of chronic care patients facing the end of life and the challenges of critical care delivery, there has been emerging evidence supporting the benefit of palliative care in the intensive care unit (ICU). We studied the relationship between the timing of a palliative care consult (PCC) and two utilization outcomes — length of stay (LOS) and pharmacy costs — in ventilator-assisted ICU patients.

Method:

A retrospective chart review was conducted (N = 90). Summed pharmacy costs were compared using a paired t test before and after PCC. Spearman correlations were performed between days to PCC and ICU LOS, ventilator days, and days to death following ventilator discontinuation.

Results:

Number of days from admission to PCC was correlated with total days on ventilator (ρ = 0.685, p < 0.0001) and total ICU LOS (ρ = 0.654, p < 0.0001). Number of days to PCC was correlated with pre-PCC total medication costs (ρ = 0.539, p < 0.0001). Median medication costs were significantly reduced after the PCC (p < 0.0001), from $230.96 to 30.62. Median medication costs decreased for all categories except for analgesics, antiemetics, and opioids. The number of patients receiving opioid infusion increased (37 vs. 90%) after PCC (p < 0.0001).

Significance of results:

Earlier timing for PCC in the ICU is associated with a lower LOS through quicker mechanical ventilation (MV) withdrawal, presenting a unique opportunity to both decrease costs and improve patient care.

Keywords

Palliative care consultIntensive care unitMechanical ventilationPharmacy costs
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 217 - 221
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

Angus, D.C., Barnato, A.E., Linde-Zwirble, W.T., et al. (2004). Use of intensive care at the end of life in the United States: An epidemiologic study. Critical Care Medicine, 32(3), 638–643.Google Scholar
Bendaly, E.A., Groves, J., Juliar, B., et al. (2008). Financial impact of palliative care consultation in a public hospital. Journal of Palliative Medicine, 11(10), 1304–1308.CrossRefGoogle ScholarPubMed
Chochinov, H.M. & Kristjanson, L. (1998). Dying to pay: The cost of end-of-life care. Journal of Palliative Care, 14(4), 5.Google Scholar
Combes, A., Costa, M.A., Trouillet, J.L., et al. (2003). Morbidity, mortality, and quality-of-life outcomes of patients requiring ≥14 days of mechanical ventilation. Critical Care Medicine, 31(5), 1373.Google Scholar
Cooke, C.R., Hotchkin, D.L., Engelberg, R.A., et al. (2010). Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU. Chest, 138(2), 289–297.Google Scholar
Cox, C.E., Carson, S.S., Lindquist, J.H., et al. (2007). Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: A prospective cohort study. Critical Care, 11(1), R9–R9.Google Scholar
Dartmouth Atlas of Health Care, The (2012). Available from http://www.dartmouthatlas.org/.Google Scholar
Epker, J.L., Bakker, J. & Kompanje, E.J.O. (2011). The use of opioids and sedatives and time until death after withdrawing mechanical ventilation and vasoactive drugs in a Dutch intensive care unit. Anesthesia and Analgesia, 112(3), 628–634.Google Scholar
Esteban, A., Anzueto, A., Frutos, F., et al. (2002). Characteristics and outcomes in adult patients receiving mechanical ventilation. The Journal of the American Medical Association, 287(3), 345–355.Google Scholar
Gerstel, E., Engelberg, R.A., Koepsell, T., et al. (2008). Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. American Journal of Respiratory and Critical Care Medicine, 178(8), 798–804.Google Scholar
Lubitz, J. & Prihoda, R. (1984). The use and costs of Medicare services in the last 2 years of life. Health Care Financing Review, 5(3), 117.Google Scholar
Lubitz, J.D. & Riley, G.F. (1993). Trends in Medicare payments in the last year of life. New England Journal of Medicine, 328(15), 1092–1096.Google Scholar
Mularski, R.A., Heine, C.E., Osborne, M.L., et al. (2005). Quality of dying in the ICU: Ratings by family members. Chest, 128(1), 280–287.CrossRefGoogle ScholarPubMed
Mularski, R.A., Puntillo, K., Varkey, B., et al. (2009). Pain management within the palliative and end-of-life care experience in the ICU. Chest, 135(5), 1360–1369.Google Scholar
Norton, S.A., Hogan, L.A., Holloway, R.G., et al. (2007). Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients. Critical Care Medicine, 35(6), 1530–1535.Google Scholar
O'Mahony, S., Blank, A.E., Zallman, L., et al. (2005). The benefits of a hospital-based inpatient palliative care consultation service: Preliminary outcome data. Journal of Palliative Medicine, 8(5), 1033–1039.Google Scholar
Riley, G.F. & Lubitz, J.D. (2010). Long-term trends in Medicare payments in the last year of life. Health Services Research, 45(2), 565–576.Google Scholar
Schönhofer, B., Euteneuer, S., Nava, S., et al. (2002). Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Medicine, 28(7), 908–916.Google Scholar
Selecky, P.A., Eliasson, C.A.H., Hall, R.I., et al. (2005). Palliative and end-of-life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement. Chest, 128(5), 3599–3610.CrossRefGoogle ScholarPubMed
Truog, R., Campbell, M. & Curtis, J. (2008). Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine, 36(3), 953–963.Google Scholar
Unroe, M., Kahn, J.M., Carson, S.S., et al. (2010). One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation. Annals of Internal Medicine, 153(3), 167–175.Google Scholar
Yu, W. (2006). End-of-life care: Medical treatments and costs by age, race, and region. In Health Services Research and Development. Available from http://www.hsrd.research.va.gov/research/abstracts/IIR_02-189.htm.Google Scholar
Zilberberg, M.D. & Shorr, A.F. (2008). Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: Implications for budgets, plant and personnel planning. BMC Health Services Research, 8(1), 242.Google Scholar