Inpatient Goals-of-Care Conversations Reduce Intensive Care Unit Transfers in High-Risk Patients.

Inpatient Goals-of-Care Conversations Reduce Intensive Care Unit Transfers in High-Risk Patients. Am J Hosp Palliat Care. 2019 Jan 17;:1049909118824546 Authors: Deptola AZ, Riggs J Abstract Despite an aging population and an increase in the prevalence of chronic severe illness, many patients will not have end-of-life care discussions with their outpatient physicians. This very likely contributes to considerable hospital utilization toward the end of life, without any clear benefit. At our medical center, we noticed a very high rate of floor-to-intensive care unit (ICU) transfers for patients with life-limiting illness and poor prognosis. We initiated a quality assessment and improvement project aimed at increasing goals-of-care conversations for high-risk patients early in their hospital stays. Patients were identified using a risk assessment score combined with presence of life-limiting illness and alerting the inpatient attending physician to the patient's severity of illness. Inpatient attending physicians were encouraged to expeditiously initiate and document goals-of-care discussions with their patients and families or to consult palliative care. Patient data were extracted retrospectively from high-risk patients prior to and during the intervention period. Analysis showed a significant increase in overall goals-of-care discussions and a significant reduction in floor-to-ICU transfers during initial admission. There was no chang...
Source: The American Journal of Hospice and Palliative Care - Category: Palliative Care Authors: Tags: Am J Hosp Palliat Care Source Type: research