Skip to main content Accessibility help

The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients

  • Glen Digwood (a1), Dana Lustbader (a1), Renee Pekmezaris (a1) (a2) (a3) (a4), Martin L. Lesser (a1) (a3) (a4), Rajni Walia (a1), Michael Frankenthaler (a1) and Erfan Hussain (a1)...


Objective: This study evaluates the impact of a 10-bed inpatient palliative care unit (PCU) on medical intensive care unit (MICU) mortality and length of stay (LOS) for terminally ill patients following the opening of an inpatient PCU. We hypothesized that MICU mortality and LOS would be reduced through the creation of a more appropriate location of care for critically ill MICU patients who were dying.

Method: We performed a retrospective electronic database review of all MICU discharges from January 1, 2006 through December 31, 2009 (5,035 cases). Data collected included MICU mortality, MICU LOS, and mean age. The PCU opened on January 1, 2008. We compared location of death for MICU patients during the 2-year period before and the 2-year period after the opening of the PCU.

Results: Our data showed that the mean MICU mortality and MICU LOS both significantly decreased following the opening of the PCU, from 21 to 15.8% (p = 0.003), and from 4.6 to 4.0 days (p = 0.014), respectively.

Significance of results: The creation of an inpatient PCU resulted in a statistically significant reduction in both MICU mortality rate and MICU LOS, as terminally ill patients were transitioned out of the MICU to the PCU for end-of-life care. Our data support the hypothesis that a dedicated inpatient PCU, capable of providing care to patients requiring mechanical ventilation or vasoactive agents, can protect terminally ill patients from an ICU death, while providing more appropriate care to dying patients and their loved ones.


Corresponding author

Address correspondence and reprint requests to: Renee Pekmezaris, 175 Community Drive, Great Neck, NY 11021. E-mail:


Hide All
Azoulay, E.,Pochard, F.,Kentish–Barnes, N., et al. (2005). Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 171, 987994.
Bradley, C.T. & Brasel, K.J. (2009). Developing guidelines that identify patients who would benefit from palliative care services in the surgical intensive care unit. Critical Care Medicine, 37, 946950.
Campbell, M.L. & Guzman, J.A. (2003). Impact of a proactive approach to improve end of life care in the medical ICU. Chest, 123, 266271.
Gelinas, C. (2007). Management of pain in cardiac surgery ICU patients: Have we improved over time? Intensive and Critical Care Nursing, 23, 298303.
Goodman, D.C., Esty, A.R., Fisher, E.S., et al. (2011). Trends and variation in end of life care for Medicare beneficiaries with severe chronic illness. The Dartmouth Institute for Health Policy and Clinical Practice. Available at: Accessed October 11, 2011.
Goodman, D.C., Fisher, E.S., Chang, C.H., et al. (2010). Quality of end-of-life cancer care for Medicare beneficiaries regional and hospital-specific analyses. The Darmouth Institute for Health Policy and Clinical Practice, 152. Available at: Accessed October 11, 2011.
Hanson, L.C., Usher, B., Spragens, L., et al. (2008). Clinical and economic impact of palliative care consultation. Journal of Pain and Symptom Management, 35, 340346.
Morrison, R.S., Penrod, J.D., Cassel, J.B., et al. (2008). Cost savings associated with US hospital palliative care consultation programs. Archives of Internal Medicine, 168 (16), 17831790.
Nelson, J.E. (2006). Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit. Critical Care Medicine, 34, S324S331.
Pochard, F., Azoulay, E., Chevret, S., et al. (2001). French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Critical Care Medicine, 29, 18931897.
Prendergast, T.J. & Luce, J.M. (1997). Increasing incidence of withholding and withdrawal of life support from the critically ill. American Journal of Respiratory Critical Care Medicine, 155, 1520.
Smith, T., Coyne, P., Cassel, B., et al. (2003). A high-volume specialist palliative care unit and team may reduce in-hospital end of life care costs. Journal of Palliative Medicine, 6, 699705.
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 treatment (SUPPORT). Journal of the American Medical Association, 274, 15911598.
Teno, J.M., Clarridge, B.R., Casey, V., et al. (2004). Family perspectives on end of life care at the last place of care. Journal of the American Medical Association, 291, 8893.
Zar, J.H. (1984). Biostatistical Analysis, 2nd ed.Englewood Cliffs: Prentice Hall.
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? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed