Lutmer Jeffrey E, Humphrey Lisa, Kempton Tanya Maria, Moore-Clingenpeel Melissa, Ayad Onsy
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. 2Pediatric Palliative Care and Hospice Medicine, Nationwide Children's Hospital, Columbus, OH. 3Biostatistics Core at the Nationwide Children's Hospital Research Institute, Columbus, OH.
Pediatr Crit Care Med. 2016 Aug;17(8):e335-42. doi: 10.1097/PCC.0000000000000848.
To test the ability of palliative care screening criteria to improve access to palliative care services in the PICU and examine the association between palliative care team involvement and ICU and hospital length of stay.
Prospective interventional quality improvement study.
PICU at a quaternary academic medical center.
All patients admitted to the PICU who met criteria for palliative care referral over a 9-month period.
Consensus palliative care consultation criteria were created by pediatric critical care medicine and palliative care providers, and palliative care referral was encouraged for all PICU patients meeting criteria.
Palliative care referral rates increased significantly after screening criteria implementation. We identified 100 patients who were eligible for palliative care services, and referrals were made for 70 patients (70%). Patients were divided into three groups based on palliative care status: patients new to the palliative care team, patients with an existing palliative care relationship, and patients who did not have a palliative care referral. By the end of study, patients who had an existing relationship with the palliative care team were more likely to still be alive and to have limitations of medical interventions in place, whereas patients who did not have a palliative care referral were more likely to be deceased and to have died in the PICU. After correcting for other factors, including severity of illness, patients who were new to the palliative care team experienced greater delay in palliative care referral and had significantly longer PICU and hospital length of stay than those who were already known to the palliative care team.
Palliative care screening criteria are effective tools for improving access to palliative care services in the PICU; however, widespread adoption may produce a significant increase in palliative care demand. The association between an existing palliative care relationship and reduction in resource utilization deserves further investigation as does the perceived benefit of palliative care involvement in the patient, family, and staff experience.
测试姑息治疗筛查标准在改善儿科重症监护病房（PICU）姑息治疗服务可及性方面的能力，并研究姑息治疗团队参与与重症监护病房及住院时间之间的关联。
前瞻性干预性质量改进研究。
一所四级学术医疗中心的PICU。
在9个月期间入住PICU且符合姑息治疗转诊标准的所有患者。
儿科重症医学和姑息治疗提供者制定了共识性姑息治疗会诊标准，并鼓励所有符合标准的PICU患者进行姑息治疗转诊。
实施筛查标准后，姑息治疗转诊率显著提高。我们确定了100名符合姑息治疗服务条件的患者，其中70名患者（70%）进行了转诊。根据姑息治疗状态，患者被分为三组：姑息治疗团队新接触的患者、已有姑息治疗关系的患者以及未进行姑息治疗转诊的患者。到研究结束时，与姑息治疗团队已有关系的患者更有可能存活且实施了医疗干预限制措施，而未进行姑息治疗转诊的患者更有可能死亡且在PICU死亡。在校正包括疾病严重程度等其他因素后，姑息治疗团队新接触的患者在姑息治疗转诊方面经历了更长的延迟，其PICU及住院时间显著长于姑息治疗团队已知的患者。
姑息治疗筛查标准是改善PICU姑息治疗服务可及性的有效工具；然而，广泛采用可能会使姑息治疗需求显著增加。现有姑息治疗关系与资源利用减少之间的关联值得进一步研究，姑息治疗参与对患者、家庭及医护人员体验的感知益处也值得研究。
