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Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit.

Abstract：

: Background: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. Objective: This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU. Design: Demographic variables and elements pertaining to the end-of-life care were obtained retrospectively via the electronic medical record from patients receiving their care at the University of Alabama at Birmingham Hospital neuro-ICU. The patient population was divided into two cohorts: patients who received PC services and patients who did not. Contingency analysis was performed to assess for associations with PC service involvement. Results: A total of 149 patients were included in the study. PC services were included in 56.4% of the cases. Involvement of the PC service led to more code status changes to comfort care-do-not-resuscitate p = 0.0021. This was more often a decremental change to less invasive measures rather than a direct change from full code to comfort care measures (p = 0.026). When PC specialists were involved, medications to treat anxiety/agitation, dyspnea/pain, and respiratory secretions were utilized more frequently (p < 0.001) and fewer procedures were performed on these critically ill patients within 48 hours of death (p < 0.001). Conclusion: Early involvement of the PC service has an impact on adjusting the treatment paradigm for patients suffering from devastating neurologic injuries. We recommend the creation of a standardized protocol to ensure early PC consultation in the neuro-ICU based on initial patient presentation parameters, imaging characteristics, and prognosis.

journal_name

J Palliat Med

journal_title

Journal of palliative medicine

authors

Tabibian BE,Salehani AA,Kuhn EN,Davis MC,Shank CD,Fisher Iii WS

doi

10.1089/jpm.2018.0428

subject

Has Abstract

pub_date

2019-05-01 00:00:00

pages

489-492

issue

eissn

1096-6218

issn

1557-7740

journal_volume

pub_type

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Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit.