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The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients

Published online by Cambridge University Press:  22 November 2011

Glen Digwood ,
Dana Lustbader ,
Renee Pekmezaris ,
Martin L. Lesser ,
Rajni Walia ,
Michael Frankenthaler  and
Erfan Hussain
Glen Digwood
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Dana Lustbader
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Renee Pekmezaris*
Affiliation:
North Shore–LIJ Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York The Feinstein Institute for Medical Research, Manhasset, New York Hofstra University School of Medicine, Hempstead, New York
Martin L. Lesser
Affiliation:
North Shore–LIJ Health System, Great Neck, New York The Feinstein Institute for Medical Research, Manhasset, New York Hofstra University School of Medicine, Hempstead, New York
Rajni Walia
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Michael Frankenthaler
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
Erfan Hussain
Affiliation:
North Shore–LIJ Health System, Great Neck, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, 175 Community Drive, Great Neck, NY 11021. E-mail: rpekmeza@nshs.edu
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Abstract

Objective: This study evaluates the impact of a 10-bed inpatient palliative care unit (PCU) on medical intensive care unit (MICU) mortality and length of stay (LOS) for terminally ill patients following the opening of an inpatient PCU. We hypothesized that MICU mortality and LOS would be reduced through the creation of a more appropriate location of care for critically ill MICU patients who were dying.

Method: We performed a retrospective electronic database review of all MICU discharges from January 1, 2006 through December 31, 2009 (5,035 cases). Data collected included MICU mortality, MICU LOS, and mean age. The PCU opened on January 1, 2008. We compared location of death for MICU patients during the 2-year period before and the 2-year period after the opening of the PCU.

Results: Our data showed that the mean MICU mortality and MICU LOS both significantly decreased following the opening of the PCU, from 21 to 15.8% (p = 0.003), and from 4.6 to 4.0 days (p = 0.014), respectively.

Significance of results: The creation of an inpatient PCU resulted in a statistically significant reduction in both MICU mortality rate and MICU LOS, as terminally ill patients were transitioned out of the MICU to the PCU for end-of-life care. Our data support the hypothesis that a dedicated inpatient PCU, capable of providing care to patients requiring mechanical ventilation or vasoactive agents, can protect terminally ill patients from an ICU death, while providing more appropriate care to dying patients and their loved ones.

Keywords

Palliative care unitLength of stayMortality rate
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 4 , December 2011 , pp. 387 - 392
Copyright
Copyright © Cambridge University Press 2011

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