2016 Articles

Variability in frequency of consultation and needs assessed by PC services across multiple specialty ICUs

Stix, Benjamin Lacob; Wunsch, Hannah; Clancy, Caitlin; Blinderman, Craig; Hua, May

Purpose: Although studies have examined multiple aspects of implementing palliative care in an intensive care unit (ICU) setting, how different types of specialty ICU physicians use palliative care consultations is unknown.
Methods: We performed a single-center retrospective study from August 2013 - August 2015 to assess differences in use of palliative care consultation among specialized ICUs. We assessed the percentage of patients admitted to each ICU who received a palliative care consultation, the primary reason(s) for consultation, and additional needs addressed during consultation. ICU differences were compared using Chi-squared and Fisher’s exact tests.
Results: Among 13,344 admissions to all ICUs, 689 patients (5.2%) received a palliative care consultation. These patients had an in-hospital mortality of 53.1%. Consultation rates differed significantly between ICUs, with 9.8% of patients in the medical ICU (MICU) receiving consultation versus 2.0% in the cardiothoracic ICU (CTICU) and 1.9% in the neurological ICU (NICU) (p<0.001). Reasons for consultation also differed, with MICU physicians consulting for a wide range of reasons, and CTICU and NICU physicians consulting primarily for “Goals of care” and “Patient/family support”. During initial consultation, 94.4% of patients had at least one additional palliative care need addressed, and 83.2% had additional needs addressed during follow-up; the percentage of patients with additional needs was not different between ICUs (initial, p=0.10; follow-up, p=0.98).
Conclusions: Across specialty ICUs, the frequency and nature of involvement of palliative care consultants differs markedly. Most patients who received consultation had additional needs addressed, suggesting palliative care needs may be under-recognized by primary teams in some ICUs.