Palliative Care Involvement in Relation to Rapid Response Events: A Focus on Care Intensity at the End of Life
Jason M Arnold, Chuanfen Ni, Kayla Thompson, Mary Clare Lipa, Deepa Daryani, Megan Christenson, Nandita R Nadig, Susan R RussellOBJECTIVES:
To examine current practice patterns of palliative care involvement in relation to rapid response (RR) events and to evaluate its association with ICU utilization and intensity of care received before death.
DESIGN:
Retrospective cohort study of patients who underwent a RR event.
SETTING:
General medical, cardiology, oncology, and observation patients admitted to a tertiary care academic medical center in the United States.
PATIENTS:
Adults (≥ 18 yr) with an RR event.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
A total of 903 RR events occurred in 616 unique patients. The palliative care team was involved in 110 of 616 (17.9%) patients. Palliative care (PC) involvement was not associated with differences in repeat RR events or ICU transfer rates following an event. In-hospital mortality or hospice discharge occurred in 32.0% (197/616). Palliative care was involved in 36.5% (72/197) of these patients. PC involvement was associated with lower intensity of care within 24 hours before death after adjustment for age, sex, Charlson Comorbidity Index, pre-RR code status, and RR trigger (adjusted odds ratio [aOR], 0.26; 95% CI, 0.14–0.47;
CONCLUSIONS:
Palliative services may be underutilized in the RR patient population, a group with a high in-hospital mortality rate; when palliative care is consulted, it may be associated with a reduction in the intensity of interventions at the end of life.