The Impact of Palliative Care Consultion in the Intensive Care Uniton 30 Day Hospital Readmission Rates (S768)

Abstract

1.Define and explain the variables used to compare the groups in this study.2.Describe the results found in this study and explain limitations of the study. Our project expands on a previous study at our institution that assessed the effectiveness of integrating a palliative medicine (PM) consult service in the intensive care unit (Walker et al., JPM, in press). This study found a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. Although palliative services were shown to be effective in the index hospitalization, we have not yet studied the long term impact of having a palliative plan of care at discharge. We sought to 1) Quantify the difference in 30- day readmission rates between patients in the medical ICU who received a PM consultation and agreed to a palliative plan of care at discharge versus those who did, and 2) Compare these groups for one year after index hospitalization discharge in terms of further readmissions, mortality, venue of death, and hospital costs. This study is a quasi-experimental cross-sectional study using the patients identified in the prior study that received a PM consultation in the ICU and survived discharge. We obtained readmission and billing data from MedStar electronic records database and death information from an online database. Our primary outcome measure was all-cause 30-day hospital readmission. Other variables of interest included mortality, number and costs of hospital readmissions over one year of follow-up. This study was considered exempt by IRB. Of 57 patients receiving a PM consultation, 45 agreed to a palliative plan of care at discharge. 30-day readmission rates were significantly lower in the group that agreed to a palliative plan of care (7% vs 75%, p<0.001). Most of the patients (92%) without palliative plans died within one year. PM consultations resulting in a palliative plan of care have a significant impact on 30-day readmission rates.