Skip to main content
×
Home
    • Aa
    • Aa

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

  • Dana Lustbader (a1), Renee Pekmezaris (a1) (a2) (a3), Michael Frankenthaler (a1), Rajni Walia (a1), Frederick Smith (a1), Erfan Hussain (a1), Barbara Napolitano (a1) (a3) and Martin Lesser (a1) (a3)...
Abstract
AbstractObjective:

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.

Copyright
Corresponding author
Address correspondence and reprint requests to: Dana Lustbader, 300 Community Drive, Manhasset, NY11030. E-mail: lustbader@nsuh.edu
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D.C. Angus , A.E. Barnato , W.T. Linde-Zwirble , (2004). Use of intensive care at the end o life in the United States: An epidemiologic study. Critical Care Medicine, 32, 638643.

M.L. Campbell (2006). Palliative care consultation in the intensive care unit. Critical Care Medicine, 34, S355S358.

M.L. Campbell & J.A. Guzman (2003). Impact of a proactive approach to improve end of life care in the medical ICU. Chest, 123, 266271.

D. Cook , G. Rocker , J. Marshal , (2003). Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. The New England Journal of Medicine, 349, 11231132.

N.L. Keating , M.B. Landrum , S.O. Rogers , (2010). Physician factors associated with discussions about end of life care. Cancer, 116, 9981006.

F.J. Landry , J.M. Parker & Y.Y. Phillips (1992). Outcome of cardiopulmonary resuscitation in the intensive care setting. Archives of Internal Medicine, 152, 23052308.

A. Lautrette , M. Darmon , B. Megarbane , (2007). A communication strategy and brochure for relatives of patients dying in the ICU. The New England Journal of Medicine, 356, 469–78.

R.A. Mularski , C.E. Heine , M.L. Osborne , (2005). Quality of dying in the ICU: Ratings by family members. Chest, 128, 280287.

S.C. Schultz , D.C. Cullinane , M.D. Pasquale , (1996). Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation, 33, 1317.

P. Selecky , A.H. Eliassaon , R.I. Hall , (2005). Palliative and end of life care for patients with cardiopulmonary diseases. The American College of Chest Physicians Position Statement. Chest, 128, 35993610.

The Society of Critical Care Medicine Ethics Committee (1992). Attitudes of critical care medicine professionals concerning forgoing life-sustaining treatments. Critical Care Medicine, 20, 320326.

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, 15911598.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: