Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
J Palliat Med. 2021 Jun;24(6):857-864. doi: 10.1089/jpm.2020.0412. Epub 2020 Nov 6.
It is not clear whether use of specialty palliative care consults and "comfort measures only" (CMO) order sets differ by type of intensive care unit (ICU). A better understanding of palliative care provided to these patients may help address heterogeneity of care across ICU types. Examine utilization of specialty palliative care consultation and CMO order sets across several different ICU types in a multihospital academic health care system. Retrospective cohort study using Washington State death certificates and data from the electronic health record. Adults with a chronic medical illness who died in an ICU at one of two hospitals from July 2013 through December 2018. Five ICU types were identified by patient population and attending physician specialty. Documentation of a specialty palliative care consult during a patient's terminal ICU stay and a CMO order set at time of death. For 2706 eligible decedents, ICU type was significantly associated with odds of palliative care consultation ( < 0.001) as well as presence of CMO order set at time of death ( < 0.001). Compared with medical ICUs, odds of palliative care consultation were highest in the cardiothoracic ICU and trauma ICU. Odds of CMO order set in place at time of death were highest in the neurology/neurosurgical ICU. Utilization of specialty palliative care consultations and CMO order sets varies across types of ICUs. Examining this variability within institutions may provide an opportunity to improve end-of-life care for patients with chronic, life-limiting illnesses who die in the ICU.
目前尚不清楚重症监护病房（ICU）的类型是否会影响专科姑息治疗咨询和“仅提供舒适护理”（CMO）医嘱的使用。深入了解对这些患者的姑息治疗方法可能有助于解决不同 ICU 类型之间的护理异质性问题。 本研究旨在考察多医院学术医疗系统中几种不同 ICU 类型的专科姑息治疗咨询和 CMO 医嘱的使用情况。 这是一项回顾性队列研究，使用了华盛顿州的死亡证明和电子病历中的数据。 纳入标准为 2013 年 7 月至 2018 年 12 月期间在两家医院的 ICU 中死亡的患有慢性疾病的成年人。根据患者人群和主治医生的专业领域确定了 5 种 ICU 类型。 记录患者在 ICU 临终期间的专科姑息治疗咨询情况以及在死亡时的 CMO 医嘱情况。 在 2706 名符合条件的死者中，ICU 类型与姑息治疗咨询的几率（ < 0.001）以及死亡时 CMO 医嘱的存在（ < 0.001）显著相关。与内科 ICU 相比，心胸 ICU 和创伤 ICU 的姑息治疗咨询几率最高。神经科/神经外科 ICU 的 CMO 医嘱在死亡时使用率最高。 专科姑息治疗咨询和 CMO 医嘱的使用情况因 ICU 类型而异。在机构内检查这种差异可能为改善在 ICU 中死亡的患有慢性、生命有限疾病的患者的临终关怀提供机会。
