Joint inpatient palliative care approaches may reduce length of stay in intensive care units

1. A joint Inpatient palliative Care (IPC) approach was effective at reducing patients’ time in the intensive care unit (ICU) and hospital overall.

Evidence Rating Level: 2 (Good)

Patients in the intensive care unit (ICU) would benefit from having an Inpatient Palliative Care (IPC) team to help them through this difficult chapter in their lives. An IPC team usually help patients manage their symptoms and pain along with providing support to them and their families and assisting with communication to ensure realistic expectations. This retrospective study enrolled 857 patients, with 431 in the pre-intervention control group and 426 in the experimental group. The study involved ICP physicians joining already established ICU multidisciplinary rounds, who were briefed on patients that could potentially benefit from IPC care, with their treatments being assessed in terms of impact on ICU length of stay. When compared to the control group, patients in the intervention group spent fewer days in the ICU (3.9 days vs. 3.7 days, p = 0.05) as well as fewer days in the hospital in total (7.8 days vs 7.5 days, p<0.01). Patients who have previously been in palliative care had longer ICU LOS (RR 1.46, 95% CI 1.04-2.06, p = 0.03) compared to patients who received the intervention, which had shorter ICU LOS (RR 0.82, 95% CI 0.70-0.97, p = 0.02). In conclusion, a joint IPC-ICU approach reduced the patients’ time in the ICU and hospital statistically, however, the low magnitude of the changes leaves questions about the general applicability of this study. The broadness of the study may have contributed to the statistical difference, despite the low magnitude. Additionally, the retrospective nature of the study leaves more questions as to the mechanism of how the addition of IPC staff contributed to the decrease in ICU times.

Click to read the study in PLOSONE

Image: PD

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