Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

Incorporating Early Palliative Medicine Consultation Into Daily Morning Huddle in the ICU

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OBJECTIVES:.Early palliative medicine consult in the ICU can significantly improve outcomes in high-risk patients.We describe a pilot study of including a recommendation for palliative medicine consult in the ICU morning huddle.DESIGN:.

A prospective, observational, quality abc material improvement study.PATIENTS AND SETTING:.Adult patients (age above 18 yr) admitted with cardiac arrest, stage IV cancer, admission from a long-term acute care facility, and circulatory shock on mechanical ventilation to the medical ICU.INTERVENTIONS:.

We aim to assess the effect of an early palliative medicine consultation in selected high-risk patients on change in code status, referral to hospice, tracheostomy, and or percutaneous gastrostomy tube placement.MEASUREMENTS AND MAIN RESULTS:.There were 83 patients who triggered an early palliative medicine consult.Palliative medicine consultation occurred in 44 patients (53%); 23 patients (28%) had a palliative medicine consult within the first 48 hours, 21 (25%) had a palliative medicine consult afterwards.

There was a significantly higher number of patients who de-escalated their code status in the palliative medicine consult group compared with the no palliative medicine consult group (63.6% vs 7.7%); however, the number was higher in the late palliative medicine consult group (71.4% vs 56.

5%).There were more patients referred to hospice in the palliative jmannino.com medicine consult group.No difference in length of stay was observed.CONCLUSIONS:.

Early palliative medicine consultation in the daily ICU morning huddle is achievable, can produce a palliative medicine consultation in most cases, and results in a significant change in code status toward less aggressive measures.