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The relationship between the timing of a palliative care consult and utilization outcomes for ventilator-assisted intensive care unit patients

Published online by Cambridge University Press:  29 October 2013

Salonie Pereira ,
Andrzej Kozikowski ,
Renee Pekmezaris ,
Suzanne Sunday ,
Tanveer Mir ,
Maha Saad ,
Lauren Corrado  and
Gisele Wolf-Klein
Salonie Pereira
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Andrzej Kozikowski*
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York
Renee Pekmezaris
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Suzanne Sunday
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Feinstein Institute for Medical Research, Manhasset, New York
Tanveer Mir
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Maha Saad
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York St John's University College of Pharmacy and Health Sciences, Queens, New York Long Island Jewish Medical Center, New Hyde Park, New York
Lauren Corrado
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Gisele Wolf-Klein
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Andrzej Kozikowski, North Shore–Long Island Jewish Health System, 175 Community Drive, Second Floor, Great Neck, New York 11021. E-mail: akozikowski@nshs.edu
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Abstract

Objective:

Given the great number of chronic care patients facing the end of life and the challenges of critical care delivery, there has been emerging evidence supporting the benefit of palliative care in the intensive care unit (ICU). We studied the relationship between the timing of a palliative care consult (PCC) and two utilization outcomes — length of stay (LOS) and pharmacy costs — in ventilator-assisted ICU patients.

Method:

A retrospective chart review was conducted (N = 90). Summed pharmacy costs were compared using a paired t test before and after PCC. Spearman correlations were performed between days to PCC and ICU LOS, ventilator days, and days to death following ventilator discontinuation.

Results:

Number of days from admission to PCC was correlated with total days on ventilator (ρ = 0.685, p < 0.0001) and total ICU LOS (ρ = 0.654, p < 0.0001). Number of days to PCC was correlated with pre-PCC total medication costs (ρ = 0.539, p < 0.0001). Median medication costs were significantly reduced after the PCC (p < 0.0001), from $230.96 to 30.62. Median medication costs decreased for all categories except for analgesics, antiemetics, and opioids. The number of patients receiving opioid infusion increased (37 vs. 90%) after PCC (p < 0.0001).

Significance of results:

Earlier timing for PCC in the ICU is associated with a lower LOS through quicker mechanical ventilation (MV) withdrawal, presenting a unique opportunity to both decrease costs and improve patient care.

Keywords

Palliative care consultIntensive care unitMechanical ventilationPharmacy costs
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 217 - 221
Copyright
Copyright © Cambridge University Press 2013 

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