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Abstract

Background:

The COVID-19 pandemic created surges of rapidly deteriorating patients straining health care necessitating the evaluation of novel models of palliative care (PC) integration to reduce patient suffering and hospital strain.

Objective:

To evaluate an integrated PC model's effect on code status change.

Design:

This is an observational retrospective study.

Setting:

Urban quaternary referral center in the southeastern United States from April 6th to August 20th, 2020.

Patients:

All patients admitted to our medical intensive care unit and stepdown unit were diagnosed with COVID-19.

Measurements:

Code status change, multivariate regression on patient characteristics.

Results:

In total, 79.7% (98/123) patients were full code at admission. After PC consultation, 33.3% (41/123) patients remained full code, 13.0% (16/123) were do not resuscitate (DNR), and 53.6% (66/123) changed to DNR/do not intubate (DNI). An ordinal logistic model determined that consultation location (odds ratio [OR] 3.35, p = 0.017) and patient age (OR 1.09, p < 0.001) were predictive of code status change to DNR/DNI.

Conclusion:

Within an integrated PC model, PC consultation was associated with code status change. The effect of an integrated PC model warrants further study in comparison with a traditional PC model in a similar patient cohort.

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