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Abstract

Background:

Referrals to palliative care for patients at the end of life in the intensive care unit (ICU) often happen late in the ICU stay, if at all. The integration of a palliative medicine advanced practice nurse (APN) is one potential strategy for proactively identifying patients who could benefit from this service.

Objective:

To evaluate the association between the integration of palliative medicine APNs into the routine operations of ICUs and hospital costs at 2 different institutions, Montefiore Medical Center (MMC) and Rush University Medical Center.

Methods:

The association between collaborative palliative care consultation service programs and hospital costs per patient was evaluated for the 2 institutions. Hospital costs were compared for patients with and without a referral to palliative care using Mann-Whitney U tests.

Results:

Hospital nonroom and board costs at the Weiler campus of MMC were significantly lower for patients with palliative care compared with those who did not receive palliative care (Median = US$6643 vs US$12 399, P < .001). Cost differences for ICU patients with and without palliative care at Rush University Medical Center were not significantly different.

Conclusion:

Our evaluation suggests that the integration of APNs into a palliative care team for case finding may be a promising strategy, but more work is needed to determine whether reductions in cost are significant.

Keywords

team-based care health care costs palliative care advanced practice provider palliative care consultation economics

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References

Riley

Lubitz

. Long-term trends in Medicare payments in the last year of life. Health Serv Res. 2010;45(2):565–576.

Nelson

Meier

Oei

. Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29(2):277–282.

O’Mahony

McHenry

Blank

. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–165.

Truog

Campbell

Curtis

. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med. 2008;36(3):953–963.

Lanken

Terry

Delisser

. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177(8):912–927.

Selecky

Eliasson

Hall

. Palliative and end-of-life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement. Chest. 2005;128(5):3599–610.

Mosenthal

Weissman

Curtis

. Integrating palliative care in the surgical and trauma intensive care unit: a report from the improving palliative care in the intensive care unit (IPAL-ICU) project advisory board and the center to advance palliative care. Crit Care Med. 2012;40(4):1199–206.

Sihra

Harris

O’Reardon

. Using the improving palliative care in the intensive care unit (IPAL-ICU) project to promote palliative care consultation. J Pain Symptom Manage. 2011;42(5):672–675.

Nelson

Puntillo

Pronovost

. In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med. 2010;38(3):808–818.

10.

Meier

. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343–380.

11.

Delgado-Guay

Parsons

Palmer

Bruera

. Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer. 2009;115(2):437–445.

12.

Curtis

Treece

Nielsen

. Integrating palliative and critical care: evaluation of a quality-improvement intervention. Am J Respir Crit Care Med. 2008;178(3):269–275.

13.

Leggett

Wasson

Sinacore

Gamelli

. A pilot study examining moral distress in nurses working in one United States burn center. J Burn Care Res. 2013;34(5):521–528.

14.

Luce

. Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists. Crit Care Med. 1995;23(4):760–766.

15.

Post

Kuijpers

Ebels

Zijlstra

. The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis. Eur Heart J. 2010;31(16):1985–1992.

16.

Lupu

; American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899–911.

17.

Kamal

Bull

Simsa

. Burnout among palliative care clinicians in the United States: results of a national survey. J Clin Oncol. 2014;32(suppl 31; abstr 87).

18.

Centers for Medicare and Medicaid Services. Acute inpatient PPS: historical impact files for FY 94 to present. Web site. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Historical-Impact-Files-for-FY-1994-through-Present.html. Updated August 1, 2012. Accessed June 12, 2015.

19.

Bureau of Labor Statistics. Consumer price index [Series ID: CUSR0000SAM]. Web site. http://www.bls.gov/cpi. Retrieved June 12, 2015.

20.

Morrison

Penrod

Cassel

. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–1790.

21.

O’Mahony

Blank

Zallman

Selwyn

. The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data. J Palliat Med. 2005;8(5):1033–1039.

22.

O’Mahony

Blank

Simpson

. Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients. J Urban Health. 2008;85(3):443–451.

23.

Fosler

Staffileno

Fogg

O’Mahony

. Cultural differences in discussion of do-not-resuscitate status and hospice. J Hosp Palliat Nurs. 2015;17(2):128–132.

24.

Bookbinder

Glajchen

McHugh

. Nurse practitioner-based models of specialist palliative care at home: sustainability and evaluation of feasibility. J Pain Symptom Manage. 2011;41(1):25–34.

Integration of Palliative Care Advanced Practice Nurses Into Intensive Care Unit Teams

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Keywords

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References