Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit

doi:10.1097/JCMA.0000000000000297

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/24365

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/24365

Title:	Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit
Authors:	Yang, C;Yang, TT;Tsou, YJ;Lin, MH;Fan, JS;Huang, HH;Tsai, MC;Yen, DHT
Keywords:	Emergency service;Health care utilization;Palliative care
Date:	2020
Issue Date:	2022-08-09T08:01:06Z (UTC)
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
ISSN:	1726-4901
Abstract:	Background: Little is known about the characteristics of patients needing palliative care consultation in the emergency department (ED). This study aimed to investigate the impacts of initiating screening in acute critically ill patients needing palliative care on mortality, health care resources, and end-of-life (EOL) care in the intensive care unit in ED (EICU). Methods: We conducted an analysis study in Taipei Veterans General Hospital. From February 1 to July 31, 2018, acute critically ill patients in EICU were recruited. The primary outcomes were inhospital mortality and EOL care. The secondary outcomes included clinical characteristics and health care utilization. Results: A total of 796 patients were screened, with 396 eligible and 400 noneligible patients needing palliative care consultations. The mean age was 74.8 +/- 17.1 years, and 62.6% of the patients were male. According to logistic regression analysis, clinical predictors, including age (adjusted odds ratio [AOR], 1.028; 95% CI, 1.015-1.042), respiratory distress and/or respiratory failure (AOR, 2.670; 95% CI, 1.829-3.897), the Acute Physiology and Chronic Health Evaluation II score (AOR, 1.036; 95% CI, 1.009-1.064), Charlson Comorbidity Index score (AOR, 1.212; 95% CI, 1.125-1.306), and Glasgow Coma Scale (AOR, 0.843; 95% CI, 0.802-0.885), were statistically more significant in eligible patients than in noneligible patients. The inhospital mortality rate was significantly higher in eligible patients than that in noneligible patients (40.7% vs 11.5%, p < 0.01). Eligible patients have a higher ratio in both vasopressor and narcotic use and withdrawal of endotracheal tube than noneligible patients (p < 0.05). Conclusion: Our study results demonstrated that initiating palliative consultation for acute critically ill patients in ED had an impact on the utilization of health care resources and quality of EOL care. Further assessments of the viewpoints of ED patients and their family on palliative care consultations and hospice care are required.
URI:	http://dx.doi.org/10.1097/JCMA.0000000000000297 https://www.webofscience.com/wos/woscc/full-record/WOS:000532308200015 https://ir.csmu.edu.tw:8080/handle/310902500/24365
Relation:	JOURNAL OF THE CHINESE MEDICAL ASSOCIATION ,2020 ,v83 ,issue 5 ,p500-506
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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