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Early palliative care linked to shorter stays in intensive care
June 14, 2007Researchers at the University of Rochester Medical Center have found that early palliative care interventions can reduce the length of stay for seriously ill patients in the medical intensive care unit (MICU) by more than seven days without having an impact on mortality rates.
Historically, palliative care was most strongly associated with end-of-life care with palliative care specialists seeing patients very late in their illness - often after patients had already been in intensive care for two weeks or more or after all other life-prolonging interventions had been exhausted. The Rochester study, published in the June issue of Critical Care Medicine, sought to address this gap by instituting and evaluating the impact of early proactive palliative care consultations on high-risk patients' length of stay in the MICU, length of hospital stay, and mortality.
"One goal of a palliative care consultation is to provide assistance and support to patients and their families while they make health care decisions," said Sally Norton, Ph.D., R.N., assistant professor at the University of Rochester School of Nursing and lead author of the study. "Palliative care consultations are designed to help patients and their families to more fully understand their medical condition, the benefits and burdens of treatments, and likely outcomes to help them make the most informed decisions about the treatments as possible. By earlier identification of patients whose medical treatments are no longer in line with their personal goals we can better alleviate their pain, manage symptoms, and get them into an environment they prefer, thereby improving their overall quality of life."
The study looked at the impact of palliative care interventions on all 191 patients admitted to the MICU at Strong Memorial Hospital in Rochester, NY, between March 2004 and March 2005 identified as having a serious illness and at high risk of dying. The patients were screened by physician and nursing palliative care leaders within 72 hours of admission.
Patients admitted during first phase of the study received a palliative care consultation only after a MICU physician referral as was the standard practice prior to the study. High-risk patients admitted during the second phase received a proactive palliative care consultation shortly after admission. The study found that patients in the proactive phase had significantly shorter lengths of stay in the MICU than those in the first phase, while there was no difference between the two groups on total length of stay in the hospital or mortality rates.
"Palliative care is not about giving up on the most aggressive treatment," said Timothy Quill, M.D., director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center and co-author of the study. "It's about empowering the sickest and most vulnerable patients and their families with the tools and information they need to do what they feel is best. Early palliative care interventions are a value-added service we can provide to these individuals and their families, and improve care in the MICU setting."
In addition to improving quality of care, proactive palliative care consultation in the MICU has an unintended, yet relevant, benefit of financial savings. Extrapolating from the study's findings, the intervention potentially saved approximately 1,400 MICU patient days at a savings of around $450 per day. In a hospital like Strong where the MICU regularly operates at 100-percent capacity, such an improvement in efficiency frees beds for patients in the emergency department and elsewhere who are in need of critical care. Recognizing and demonstrating these indirect financial effects is critical to ensuring palliative care consultation services continue to expand in hospital settings nationwide.
University of Rochester Medical Center
The study looked at the impact of palliative care interventions on all 191 patients admitted to the MICU at Strong Memorial Hospital in Rochester, NY, between March 2004 and March 2005 identified as having a serious illness and at high risk of dying. The patients were screened by physician and nursing palliative care leaders within 72 hours of admission.
Patients admitted during first phase of the study received a palliative care consultation only after a MICU physician referral as was the standard practice prior to the study. High-risk patients admitted during the second phase received a proactive palliative care consultation shortly after admission. The study found that patients in the proactive phase had significantly shorter lengths of stay in the MICU than those in the first phase, while there was no difference between the two groups on total length of stay in the hospital or mortality rates.
"Palliative care is not about giving up on the most aggressive treatment," said Timothy Quill, M.D., director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center and co-author of the study. "It's about empowering the sickest and most vulnerable patients and their families with the tools and information they need to do what they feel is best. Early palliative care interventions are a value-added service we can provide to these individuals and their families, and improve care in the MICU setting."
In addition to improving quality of care, proactive palliative care consultation in the MICU has an unintended, yet relevant, benefit of financial savings. Extrapolating from the study's findings, the intervention potentially saved approximately 1,400 MICU patient days at a savings of around $450 per day. In a hospital like Strong where the MICU regularly operates at 100-percent capacity, such an improvement in efficiency frees beds for patients in the emergency department and elsewhere who are in need of critical care. Recognizing and demonstrating these indirect financial effects is critical to ensuring palliative care consultation services continue to expand in hospital settings nationwide.
University of Rochester Medical Center
Palliative Care Current Events and Palliative Care News RSSDying from dementia
A growing number of older adults are dying from dementia. In an editorial in the October 15, 2009 issue of the New England Journal of Medicine, Greg Sachs, M.D., professor of medicine and director of the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine and a Regenstrief Institute investigator, notes that end-of-life care for most older adults with dementia has not changed in decades and urges that these individuals be provided far greater access to palliative care, the management of pain and other symptoms.
Calculate benefit before dialysis for frail elders
Kidney specialists should weigh the potential quality of life for frail elders with end-stage renal disease (ESRD) in opting for dialysis over more conservative therapies, a nephrologist and a palliative care specialist suggest in an editorial in the New England Journal of Medicine.
Instanyl sets new standard in management of breakthrough cancer pain
New data presented today further demonstrate the efficacy of Instanyl in management of breakthrough cancer pain. The data which were presented at the 6th congress of the European Federation of Chapters of the International Association for the Study of Pain (EFIC) are from a multinational, crossover trial comparing Instanyl with oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in patients with cancer.
Expanded insurance benefits break down barriers to hospice care, according to new study
Patients with advanced illnesses more than doubled their use of hospice care when a major national health plan made hospice care more readily accessible, according to the results of a comparative study published in Journal of Palliative Medicine.
Palliative care intervention for patients with advanced cancer provides quality of life benefits
Patients with advanced cancer who received a palliative care intervention focused on addressing physical and psychosocial issues and care coordination that was provided at the same time as cancer treatment reported improved quality of life and mood but did not experience a significant change in the number of days in the hospital or the severity of their symptoms compared to patients who received usual care.
Atrial fibrillation linked to increased hospitalization in heart failure patients
Patients with atrial fibrillation, common in those with advanced chronic heart failure, have an increased risk of hospitalization due to heart failure.
Acupuncture Eases Radiation-Induced Dry Mouth in Cancer Patients
Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.
Young women warned of lung cancer risks
Seventeen people are still dying from lung cancer each week in Northern Ireland despite a small improvement in survival rates for the disease.
Study finds race and ethnicity affect use of hospice services among patients with advanced cancer
Race and ethnicity appear to have an effect on whether a patient with terminal cancer uses hospice care services, according to a study led by researchers at Beth Israel Deaconess Medical Center (BIDMC).
Brown Expert Offers Guide to End-of-Life Care
Years ago, dying patients in most communities often had a single option if they needed hospice care. Now they have many more; competition reigns.
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