Quality Improvement in Palliative Care Consultation in a Medical ICU

Palliative Care Clinical Trial

Official title:

Quality Improvement in Palliative Care Consultation in a Medical Intensive Care Unit

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT03210116
• Other study ID #: 201705046
• Status: Withdrawn
• Phase: N/A
• First received: June 25, 2017
• Last updated: July 26, 2017
• Start date: July 2017
• Est. completion date: August 2018

Study information

• Verified date: July 2017
• Source: Washington University School of Medicine
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

A quality improvement project compares automatic palliative care consultation compared to standard of care in the medical intensive care unit (ICU). The study will assess if the intervention leads to an increased proportion of clearly delineated goals of care and quality of life and examine if this intervention leads to decreased length of days in the ICU, Hospital, and on mechanical ventilation.

Description:

• The medical intensive care unit will be split into two groups, assigned as either automatic palliative care consultation or standard of care.

• A palliative care screening tool will be used to determine if a newly admitted patient is eligible for palliative care consultation. For patients in the standard of care group, medical records will be reviewed.

• The two medical ICU groups will be crossed over to the after 3 months for a total of 6 months of study.

• Participants will be followed through his or her hospitalization.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: August 2018
• Est. primary completion date: April 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Admitted to ICU in the last 24 hours

• Admitted from skilled nursing facility (SNF), long term acute care (LTAC) facility, long term ventilator care (vent LTC) unit, or home care with private duty nursing with activity of daily living (ADL) dependencies

• End-stage dementia, amyotrophic lateral sclerosis, Parkinson's, multiple Sclerosis

• Advanced or Metastatic Cancer

• Cardiac or respiratory arrest with neurological compromise

• Multi-organ system failure (more than 2 organ failures)

• Known diagnosis of end stage organ disease including cirrhosis, end-stage renal disease, congestive heart failure New York Heart Association > III, chronic obstructive pulmonary disease on home O2

• Shock requiring > 6 hours of vasopressors or inotropes

• Acute respiratory failure requiring intubation or non invasive positive pressure ventilation

• Admitted to ICU with hospital length of stay of more than 5 days or ICU readmission with the same diagnosis in 30 days.

Exclusion Criteria:

• Solid organ or stem cell transplant patients

• Patients who do not speak English if interpreter is unavailable

• Patients without capacity to participate in palliative care discussions without a surrogate available

• Patient or patient surrogate refusal of palliative care consultation

Related Conditions & MeSH terms

• Palliative Care
• Quality Improvement

Intervention

Other:
• Palliative Care
Palliative Care Consultation

Locations

Country	Name	City	State
United States	Barnes Jewish Hospital	Saint Louis	Missouri

Sponsors (1)

Lead Sponsor	Collaborator
Washington University School of Medicine

Country where clinical trial is conducted

United States, 

References & Publications (6)

Adelson K, Paris J, Horton JR, Hernandez-Tellez L, Ricks D, Morrison RS, Smith CB. Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use. J Oncol Pract. 2017 May;13(5):e431-e440. doi: 10.1200/JOP.2016.016808. Epub 2017 Mar 17. — View Citation

Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014 Feb;17(2):219-35. doi: 10.1089/jpm.2013.0409. Review. — View Citation

Hsu-Kim C, Friedman T, Gracely E, Gasperino J. Integrating Palliative Care into Critical Care: A Quality Improvement Study. J Intensive Care Med. 2015 Sep;30(6):358-64. doi: 10.1177/0885066614523923. Epub 2014 Mar 5. — View Citation

Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med. 2015 May;43(5):1102-11. doi: 10.1097/CCM.0000000000000852. Review. — View Citation

Kyeremanteng K, Gagnon LP, Thavorn K, Heyland D, D'Egidio G. The Impact of Palliative Care Consultation in the ICU on Length of Stay: A Systematic Review and Cost Evaluation. J Intensive Care Med. 2016 Aug 31. pii: 0885066616664329. [Epub ahead of print] — View Citation

Penrod JD, Pronovost PJ, Livote EE, Puntillo KA, Walker AS, Wallenstein S, Mercado AF, Swoboda SM, Ilaoa D, Thompson DA, Nelson JE. Meeting standards of high-quality intensive care unit palliative care: clinical performance and predictors. Crit Care Med. 2012 Apr;40(4):1105-12. doi: 10.1097/CCM.0b013e3182374a50. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	ICU Length of Stay		Through study completion, an average of 1 year
Primary	Hospital length of stay		Through study completion, an average of 1 year
Primary	Cardiopulmonary resuscitation (CPR) performed		Through study completion, an average of 1 year
Primary	Days on Mechanical Ventilation		Through study completion, an average of 1 year
Secondary	Transition to comfort care or discharge to hospice		Through study completion, an average of 1 year
Secondary	Total hospital stay cost		Through study completion, an average of 1 year