Palliative Care Consults Among Critically Ill Patients: Does Timing Matter?

Abstract

Introduction

Data supports the need for palliative care for critically ill patients. It is unclear if clinicians are able to identify which patients would benefit most from an in-ICU consult by the palliative care team. Given the limitations of our data, we used in-hospital mortality as a proxy for unmet palliative care needs.

Methods

We conducted a retrospective cohort study of patients in our palliative care consultation registry who had a MICU length of stay (LOS) ≥ 72 h at Mount Sinai Hospital in 2022. Using electronic health record and administrative data, we compared the sociodemographic and clinical characteristics of patients who received an in-ICU palliative care consult and those who received a post-ICU consult.

Results

In our sample, 195 patients received an in-ICU palliative care consultation and 63 had a post-ICU consultation. There were no sociodemographic or clinical differences among the two groups. As compared to the post-ICU consult group, patients who received an in-ICU consult had a longer median ICU LOS and had more days between consult and discharge. There was no difference with regards to in-hospital mortality.

Discussion

Our findings suggest that sociodemographic and clinical indicators do not distinguish which patients receive an in-ICU consult. Yet, all patients in this sample have a high in-hospital mortality rate regardless of consult timing. Delivery models are needed to ensure more patients with a MICU LOS ≥72 h receive an in-ICU palliative care consult.