Does Palliative Care Consultation Reduce ICU Length of Stay? (313-A)

Abstract

1.Describe the results of studies that examined intensive care unit length of stay with palliative care and similar interventions.2.Discuss the results of a meta-analysis of the results of those published studies.3.Translate the findings of this review into improved research on survivors as the field continues to evolve. Background. A commonly referenced benefit of palliative care services (PCS) is that the palliative care (PC) intervention reduces intensive care unit (ICU) utilization. A number of peer-reviewed studies have presented data relevant to the claim that ICU length of stay (LOS) is reduced following PC consultation. Research objectives. Determine through systematic review whether PC consultations or similar interventions increase, reduce, or have no effect on ICU LOS. Methods. Twelve studies met our review criteria. Four studies included sub-sample analyses (separate analyses for two different patient groups) resulting in 16 analyses in our review. We conducted a meta-analysis to determine an average effect size and used regression analyses to determine whether reported effects were due to care setting, study type, or population factors. Results. Twelve of the 16 analyses found significantly lower ICU utilization among patients who received a PC or similar consultation, with an average of 4.35 fewer days (range 1.44–9.0 days). The meta-analysis found that the PC intervention had a significant impact on ICU LOS and the difference was significant regardless of intervention type (PC versus similar), type of care setting, or study design. Although the effect was significant among the studies that had all or some decedents, it was not significant for the studies that had all survivors. Conclusion. PCS leaders can expect that their programs will reduce ICU utilization. ICU utilization can be assessed as an independent outcome, or it can be considered a key driver of the financial benefits that most PCS generate. Implications for research, policy, or practice. Researchers should separate survivors and decedents in analyses of ICU LOS and should focus on outcomes for survivors, which are under-studied. PC impact on ICU LOS is more consistently demonstrated than we found in our review of total hospital LOS (JPM, 13[6], 761–767). Structure and Processes of Care