PALLIATIVE MEDICINE CONSULTATION IN THE DAILY ICU MORNING HUDDLE

Abstract

SESSION TITLE: Palliative Care and End-of-Life Issues Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Early palliative medicine consultation in the intensive care unit (ICU) for selected patients can significantly change code status and increase referral to hospice, yet it remains underutilized. The morning huddle is a multidisciplinary team brief meeting prior to rounds with a focus on patient care . We describe a pilot study of including a palliative medicine consult in the daily ICU morning huddle. METHODS: A pilot study in the medical ICU that included adult patients who are expected to be admitted for more than 24 hours. The charge nurse and case managers screened all ICU patients for 5 pre-determined triggers: admission after a cardiac arrest, stage four cancer, admission from a long-term acute care facility, prior Do-Not-Resuscitate (DNR) code status, and circulatory shock on mechanical ventilation. During the daily morning huddle, they announce patients who met the criteria and daily update a huddle board. The chart was reviewed at 48 hours of admission and until ICU discharge for whether or not an early (within 48 hours) or late (> 48 hours) palliative medicine consult occurred, code status de-escalation on ICU discharge (compared to admission), whether or not a tracheostomy or a percutaneous endoscopic gastrostomy tube were placed, and if the patient was referred to hospice. Finally, for patients who did not receive a palliative medicine consult, we interviewed the medical team to identify the reason. RESULTS: There were 83 patients who triggered an early palliative medicine consult. Median age was 71 years, mostly male (53%) and Caucasian (90%). Palliative medicine consult happened in most cases (53%); 23 patients (28%) had a palliative medicine consult within the first 48 hours, 21 (25%) had a palliative medicine consult afterwards, and 39 (47%) left the ICU with no palliative medicine consult. The etiology of not obtaining an early palliative medicine consult was a clinical decision by the treating team in 60% of cases, the rest were equally due to family decision and discharge from the ICU within 48 hours There was a significantly higher number of patients who de-escalated their code status in the palliative medicine consult group compared to the no palliative medicine consult group (63.6% versus 7.7%), however the number was higher in the late palliative medicine consult group (71.4% versus 56.5%). There were more patients referred to hospice in the palliative medicine consult group. No difference in length of stay was observed. CONCLUSIONS: Incorporated a palliative medicine consult trigger in the morning huddle was associated with a de-escalation of code status and increased referral to hospice CLINICAL IMPLICATIONS: Incorporating early palliative medicine consult is feasible and may affect outcomes without disrupting workflow. Education to ICU staff and family members should happen concomitantly DISCLOSURES: No relevant relationships by Sura Alqaisi, source=Web Response No relevant relationships by Sura Alqaisi, source=Web Response No relevant relationships by Arslan Babar, source=Web Response No relevant relationships by Katherine Eilenfeld, source=Web Response No relevant relationships by Mahmoud Mohamed Elfadil, source=Web Response