Early palliative intervention in septic patients reduces healthcare utilization.

Abstract

While the role of palliative care in the emergency department is recognized, barriers against the effective integration of palliative interventions and emergency care remain. We examined the association between goals-of-care and palliative care consultations and healthcare utilization outcomes in older adult patients who presented to the emergency department (ED) with sepsis. We performed a retrospective review of 197 patients aged 65years and older who presented to the ED with sepsis or septic shock. Healthcare utilization outcomes were compared between patients divided into 3 groups: no palliative care consultation, palliative care consultation within 4days of admission (i.e., early consultation), and palliative care consultation after 4days of admission (i.e., late consultation). 51% of patients did not receive any palliative consultation, 39% of patients underwent an early palliative care consultation (within 4days), and 10% of patients underwent a late palliative care consultation (after 4days). Patients who received late palliative care consultation had a significantly increased number of procedures, total length of stay, ICU length of stay, and cost (p<.01, p<.001, p<.05, p<.001; respectively). Regarding early palliative care consultation, there were no statistically significant associations between this intervention and our outcomes of interest; however, we noted a trend towards decreased total length of stay and decreased healthcare cost. In patients aged 65years and older who presented to the ED with sepsis, early palliative consultations were associated with reduced healthcare utilization as compared to late palliative consultations.