<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Community hospitals will often transfer their most complex, critically ill patients to intensive care units (ICUs) of tertiary care centers for specialized, comprehensive care. This population of patients has high rates of morbidity and mortality. Palliative care involvement in critically ill patients has been demonstrated to reduce over-utilization of resources and hospital length of stays. We hypothesized that transfers from community hospitals had low rates of palliative care involvement and high utilization of ICU resources. In this single-center retrospective cohort study, 848 patients transferred from local community hospitals to the medical ICU (MICU) and cardiac care unit (CCU) at a tertiary care center between 2016-2018 were analyzed for patient disposition, length of stay, hospitalization cost, and time to palliative care consultation. Of the 848 patients, 484 (57.1%) expired, with 117 (13.8%) having expired within 48 hours of transfer. Palliative care consult was placed for 201 (23.7%) patients. Patients with palliative care consult were statistically more likely to be referred to hospice (p&lt;0.001). Over two-thirds of palliative care consults were placed later than 5 days after transfer. Time to palliative care consult was positively correlated with length of hospitalization among MICU patients (r=0.79) and CCU patients (r=0.90). Time to palliative consult was also positively correlated with hospitalization cost among MICU patients (r=0.75) and CCU patients (r=0.86). These results indicate early palliative care consultation in this population may result in timely goals of care discussions and optimization of resources.</p>

</abstract>

Community hospitals will often transfer their most complex, critically ill patients to intensive care units (ICUs) of tertiary care centers for specialized, comprehensive care. This population of patients has high rates of morbidity and mortality. Palliative care involvement in critically ill patients has been demonstrated to reduce over-utilization of resources and hospital length of stays. We hypothesized that transfers from community hospitals had low rates of palliative care involvement and high utilization of ICU resources. In this single-center retrospective cohort study, 848 patients transferred from local community hospitals to the medical ICU (MICU) and cardiac care unit (CCU) at a tertiary care center between 2016-2018 were analyzed for patient disposition, length of stay, hospitalization cost, and time to palliative care consultation. Of the 848 patients, 484 (57.1%) expired, with 117 (13.8%) having expired within 48 hours of transfer. Palliative care consult was placed for 201 (23.7%) patients. Patients with palliative care consult were statistically more likely to be referred to hospice (p<0.001). Over two-thirds of palliative care consults were placed later than 5 days after transfer. Time to palliative care consult was positively correlated with length of hospitalization among MICU patients (r=0.79) and CCU patients (r=0.90). Time to palliative consult was also positively correlated with hospitalization cost among MICU patients (r=0.75) and CCU patients (r=0.86). These results indicate early palliative care consultation in this population may result in timely goals of care discussions and optimization of resources.

Impact of Palliative Care on Interhospital Transfers to the Intensive Care Unit

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

{"article-title":"Impact of Palliative Care on Interhospital Transfers to the Intensive Care Unit"}

Community hospitals will often transfer their most complex, critically ill patients to intensive care units (ICUs) of tertiary care centers for specialized,...

	MICU		CCU
Total Patients	475		373

Gender
Male	265	55.79%	233	62.47%
Female	210	44.21%	140	37.53%

Age
Range	19-87		19-93
Mean	57.57		67.08
Median	59		69
Mode	56		66
Standard Deviation	14.27		14.65

Ethnicity
American Indian	1	0.21%	1	0.27%
Asian	6	1.26%	4	1.07%
Black/African American	157	33.05%	108	28.95%
White	265	55.79%	240	64.34%
Other/Unknown	46	9.68%	20	5.36%

First Code Status on Record*
Full Code	259	54.53%	219	58.71%
Do NOT Intubate, No CPR	52	10.95%	43	11.53%
Intubate, No CPR	72	15.16%	17	4.56%
Limited	20	4.21%	6	1.61%
Palliative and Supportive Care, No CPR	49	10.32%	9	2.41%
None documented	23	4.84%	79	21.18%

APDRG Severity Index
Extreme	426	89.68%	233	62.47%
Major	39	8.21%	75	20.11%
Moderate	9	1.89%	49	13.14%
Minor	1	0.21%	16	4.29%
Mechanical Ventilation	349	73.47%	144	38.60%

Impact of Palliative Care on Interhospital Transfers to the Intensive Care Unit

Article Category: Research Article

Pubblicato online: 12 mag 2022

Pagine: 100 - 106

Ricevuto: 25 mar 2021

Accettato: 26 apr 2022

DOI: https://doi.org/10.2478/jccm-2022-0009

Parole chiave
palliative care, interhospital transfer, community hospital, academic health center, quality improvement

© 2022 Safanah Tabassum Siddiqui, Emily Xiao, Sonika Patel, Kiran Motwani, Keneil Shah, Xinyuan Ning, Kathryn S. Robinett, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1. A

Fig. 2

Fig. 3

Fig. 4

Patient Demographic Characteristics

Impact of Palliative Care on Interhospital Transfers to the Intensive Care Unit

Article Category: Research Article

Pubblicato online: 12 mag 2022

Pagine: 100 - 106

Ricevuto: 25 mar 2021

Accettato: 26 apr 2022

DOI: https://doi.org/10.2478/jccm-2022-0009

Parole chiavepalliative care, interhospital transfer, community hospital, academic health center, quality improvement

© 2022 Safanah Tabassum Siddiqui, Emily Xiao, Sonika Patel, Kiran Motwani, Keneil Shah, Xinyuan Ning, Kathryn S. Robinett, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1. A

Fig. 2

Fig. 3

Fig. 4

Patient Demographic Characteristics

Parole chiave
palliative care, interhospital transfer, community hospital, academic health center, quality improvement