Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.

Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.

<h4>Introduction</h4>Automated specialty palliative care consultation (SPC) has been proposed as an intervention to improve patient-centered care in the intensive care unit (ICU). Existing automated SPC trigger criteria are designed to identify patients at highest risk of in-hospital dea...

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Autores principales: Katharine E Secunda, Kristyn A Krolikowski, Madeline F Savage, Jacqueline M Kruser
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Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
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Acceso en línea:https://doaj.org/article/bb07566e5b8e4aa7958807847d868028
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spelling oai:doaj.org-article:bb07566e5b8e4aa7958807847d8680282021-12-02T20:18:22ZEvaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.1932-620310.1371/journal.pone.0255989https://doaj.org/article/bb07566e5b8e4aa7958807847d8680282021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255989https://doaj.org/toc/1932-6203<h4>Introduction</h4>Automated specialty palliative care consultation (SPC) has been proposed as an intervention to improve patient-centered care in the intensive care unit (ICU). Existing automated SPC trigger criteria are designed to identify patients at highest risk of in-hospital death. We sought to evaluate common mortality-based SPC triggers and determine whether these triggers reflect actual use of SPC consultation. We additionally aimed to characterize the population of patients who receive SPC without meeting mortality-based triggers.<h4>Methods</h4>We conducted a retrospective cohort study of all adult ICU admissions from 2012-2017 at an academic medical center with five subspecialty ICUs to determine the sensitivity and specificity of the five most common SPC triggers for predicting receipt of SPC. Among ICU admissions receiving SPC, we assessed differences in patients who met any SPC trigger compared to those who met none.<h4>Results</h4>Of 48,744 eligible admissions, 1,965 (4.03%) received SPC; 979 (49.82%) of consultations met at least 1 trigger. The sensitivity and specificity for any trigger predicting SPC was 49.82% and 79.61%, respectively. Patients who met no triggers but received SPC were younger (62.71 years vs 66.58 years, mean difference (MD) 3.87 years (95% confidence interval (CI) 2.44-5.30) p<0.001), had longer ICU length of stay (11.43 days vs 8.42 days, MD -3.01 days (95% CI -4.30 --1.72) p<0.001), and had a lower rate of in-hospital death (48.68% vs 58.12%, p<0.001).<h4>Conclusion</h4>Mortality-based triggers for specialty palliative care poorly reflect actual use of SPC in the ICU. Reliance on such triggers may unintentionally overlook an important population of patients with clinician-identified palliative care needs.Katharine E SecundaKristyn A KrolikowskiMadeline F SavageJacqueline M KruserPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255989 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Katharine E Secunda
Kristyn A Krolikowski
Madeline F Savage
Jacqueline M Kruser
Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
description <h4>Introduction</h4>Automated specialty palliative care consultation (SPC) has been proposed as an intervention to improve patient-centered care in the intensive care unit (ICU). Existing automated SPC trigger criteria are designed to identify patients at highest risk of in-hospital death. We sought to evaluate common mortality-based SPC triggers and determine whether these triggers reflect actual use of SPC consultation. We additionally aimed to characterize the population of patients who receive SPC without meeting mortality-based triggers.<h4>Methods</h4>We conducted a retrospective cohort study of all adult ICU admissions from 2012-2017 at an academic medical center with five subspecialty ICUs to determine the sensitivity and specificity of the five most common SPC triggers for predicting receipt of SPC. Among ICU admissions receiving SPC, we assessed differences in patients who met any SPC trigger compared to those who met none.<h4>Results</h4>Of 48,744 eligible admissions, 1,965 (4.03%) received SPC; 979 (49.82%) of consultations met at least 1 trigger. The sensitivity and specificity for any trigger predicting SPC was 49.82% and 79.61%, respectively. Patients who met no triggers but received SPC were younger (62.71 years vs 66.58 years, mean difference (MD) 3.87 years (95% confidence interval (CI) 2.44-5.30) p<0.001), had longer ICU length of stay (11.43 days vs 8.42 days, MD -3.01 days (95% CI -4.30 --1.72) p<0.001), and had a lower rate of in-hospital death (48.68% vs 58.12%, p<0.001).<h4>Conclusion</h4>Mortality-based triggers for specialty palliative care poorly reflect actual use of SPC in the ICU. Reliance on such triggers may unintentionally overlook an important population of patients with clinician-identified palliative care needs.
format article
author Katharine E Secunda
Kristyn A Krolikowski
Madeline F Savage
Jacqueline M Kruser
author_facet Katharine E Secunda
Kristyn A Krolikowski
Madeline F Savage
Jacqueline M Kruser
author_sort Katharine E Secunda
title Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
title_short Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
title_full Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
title_fullStr Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
title_full_unstemmed Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study.
title_sort evaluation of automated specialty palliative care in the intensive care unit: a retrospective cohort study.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/bb07566e5b8e4aa7958807847d868028
work_keys_str_mv AT katharineesecunda evaluationofautomatedspecialtypalliativecareintheintensivecareunitaretrospectivecohortstudy
AT kristynakrolikowski evaluationofautomatedspecialtypalliativecareintheintensivecareunitaretrospectivecohortstudy
AT madelinefsavage evaluationofautomatedspecialtypalliativecareintheintensivecareunitaretrospectivecohortstudy
AT jacquelinemkruser evaluationofautomatedspecialtypalliativecareintheintensivecareunitaretrospectivecohortstudy
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