The following is a summary of “Lessons Learned from an Embedded Palliative Care Model in the Medical Intensive Care Unit,” published in the APRIL 2023 issue of Pain Management by Mehta, et al.
For a study, researchers sought to describe the implementation of a physician (MD) and registered nurse (RN) -led palliative care consultation team in the medical intensive care unit (MICU) and to compare patterns of palliative care consultation, rates of documentation of goals of care, and in-ICU mortality before and after the implementation of the embedded team. Implementing a palliative care consultation team in the MICU aimed to provide earlier palliative care consultation to critically ill patients with unmet palliative care needs.
They compared patients who received a referral-based palliative care consultation between January 1, 2019, and June 30, 2019, with those who received an embedded consultation between September 1, 2019, and February 28, 2020. In addition, sociodemographic and clinical characteristics of the patients were compared, and palliative care consultation characteristics, rates of documentation of medical decision-makers and goals of care, and in-ICU mortality rates were analyzed using electronic health record data.
In six months, 169 MICU patients received an embedded palliative care consultation, while 52 received a referral-based consultation. Patients who received an embedded consult were seen significantly earlier in hospitalization (median number of days from hospital admission to consult: 10 days [referral] vs. 3 days [embedded], P<0.001), were more likely to have documentation of medical decision-makers (40% [referral] vs. 66% [embedded], P=0.002) and goals of care (37% [referral] vs. 71% [embedded], P<0.001), and less likely to die in the hospital (75% [referral] vs. 44% [embedded], P<0.001).
Implementing palliative care, MD/RN team in the MICU led to earlier palliative care consultation for critically ill patients, improved documentation of medical decision-makers and goals of care, and reduced in-ICU mortality rates. However, further research was needed to determine how the model can be adapted to other ICUs to improve palliative care access for critically ill patients.
Reference: jpsmjournal.com/article/S0885-3924(22)01043-0/fulltext
