• Critical care medicine · Feb 2017

    Randomized Controlled Trial

    A Randomized Trial of Palliative Care Discussions Linked to an Automated Early Warning System Alert.

    • David Picker, Maria Dans, Kevin Heard, Thomas Bailey, Yixin Chen, Chenyang Lu, and Marin H Kollef.
    • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 2Palliative Care Services, Department of Medicine, Barnes-Jewish Hospital, St. Louis, MO. 3Center for Clinical Excellence, BJC HealthCare, St. Louis, MO. 4Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 5Department of Medicine, School of Engineering and Applied Sciences, Washington University in St. Louis, St. Louis, MO.
    • Crit. Care Med. 2017 Feb 1; 45 (2): 234-240.

    ObjectiveTo determine whether an Early Warning System could identify patients wishing to focus on palliative care measures.DesignProspective, randomized, pilot study.SettingBarnes-Jewish Hospital, Saint Louis, MO (January 15, 2015, to December 12, 2015).PatientsA total of 206 patients; 89 intervention (43.2%) and 117 controls (56.8%).InterventionsPalliative care in high-risk patients targeted by an Early Warning System.Measurements And Main ResultsAdvanced directive documentation was significantly greater prior to discharge in the intervention group (37.1% vs 15.4%; p < 0.001) as were first-time requests for advanced directive documentation (14.6% vs 0.0%; p < 0.001). Documentation of resuscitation status was also greater prior to discharge in the intervention group (36.0% vs 23.1%; p = 0.043). There was no difference in the number of patients requesting a change in resuscitation status between groups (11.2% vs 9.4%; p = 0.666). However, changes in resuscitation status occurred earlier and on the general medicine units for the intervention group compared to the control group. The number of patients transferred to an ICU was significantly lower for intervention patients (12.4% vs 27.4%; p = 0.009). The median (interquartile range) ICU length of stay was significantly less for the intervention group (0 [0-0] vs 0 [0-1] d; p = 0.014). Hospital mortality was similar (12.4% vs 10.3%; p = 0.635).ConclusionsThis study suggests that automated Early Warning System alerts can identify patients potentially benefitting from directed palliative care discussions and reduce the number of ICU transfers.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…