Type of Intensive Care Unit Matters: Variations in Palliative Care for Critically Ill Patients with Chronic,Life-Limiting Illness

Abstract

Background:

It is not clear whether use of specialty palliative care consults and “comfort measures only” (CMO) order sets differ by type of intensive care unit (ICU). A better understanding of palliative care provided to these patients may help address heterogeneity of care across ICU types.

Objectives:

Examine utilization of specialty palliative care consultation and CMO order sets across several different ICU types in a multihospital academic health care system.

Design:

Retrospective cohort study using Washington State death certificates and data from the electronic health record.

Setting/Subjects:

Adults with a chronic medical illness who died in an ICU at one of two hospitals from July 2013 through December 2018. Five ICU types were identified by patient population and attending physician specialty.

Measurements:

Documentation of a specialty palliative care consult during a patient's terminal ICU stay and a CMO order set at time of death.

Results:

For 2706 eligible decedents, ICU type was significantly associated with odds of palliative care consultation (p < 0.001) as well as presence of CMO order set at time of death (p < 0.001). Compared with medical ICUs, odds of palliative care consultation were highest in the cardiothoracic ICU and trauma ICU. Odds of CMO order set in place at time of death were highest in the neurology/neurosurgical ICU.

Conclusion:

Utilization of specialty palliative care consultations and CMO order sets varies across types of ICUs. Examining this variability within institutions may provide an opportunity to improve end-of-life care for patients with chronic, life-limiting illnesses who die in the ICU.