In Brief | Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study

Originally published in PLOS One

Many patients in ICU have life-limiting conditions and would benefit from the involvement of an Inpatient Palliative Care (IPC) team. Previous research has shown that access to palliative care resources in the ICU improved clinical outcomes, allowed for an easier transition in changed code status, reduced mechanical ventilation times and overall length of stay (LOC), and facilitated earlier referral to hospice.

However, even in units with access to the IPC team, knowing who would best benefit from such care and when to trigger such interventions remains challenging. 

This study aimed to determine whether integrating IPC intervention into an ICU multidisciplinary approach would affect clinical outcomes, in particular the length of stay in ICU. 

The retrospective cohort study compared two groups of ICU patients over two six-month periods. The first group consisted of 431 patients who received no Inpatient Palliative Care (IPC) intervention. In the second group, the intervention group, which comprised 426 patients, a palliative care physician participated in ICU multidisciplinary rounds twice weekly. During these rounds, the physician reviewed all patients in the ICU and recommended IPC consultation when deemed appropriate. 

The researchers reported that patients in the intervention group spent fewer days in the ICU ( 3.7 vs 3,9 days) and had a reduced overall hospital stay( 7,5 vs 7.8 days).  Fewer patients in the intervention group received CPR, but the difference was not statistically significant. Additionally, There was no significant difference in the hospital mortality rate, days on mechanical ventilation via endotracheal tube, bounce back to the ED, or hospital outcomes such as ICU and hospital LOS.

The study demonstrated that incorporating IPC into an ICU multidisciplinary model resulted in a statistically significant reduction in ICU and hospital LOS, however the clinical significance of such an initiative, including the cost-benefits, remains unclear and would require further research.

Access the original article

Shalman D. (2024). Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study. PloS one, 19(2), e0297288. https://doi.org/10.1371/journal.pone.0297288

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