Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.
Int J Environ Res Public Health. 2021 Nov 28;18(23):12546. doi: 10.3390/ijerph182312546.
The early integration of palliative care in the emergency department (ED-PC) provides several benefits, including improved quality of life with optimal comfort measures, and symptom control. Whether palliative care could affect the intensive care unit admissions, hospital care and resource utilization requires further investigation.
To determine the differences in inpatient characteristics, hospital care, survival, and resource utilization between patients receiving palliative care (ED-PC) and usual care (UC).
Retrospective observational study.
SETTING/PARTICIPANTS: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit at Taipei Veterans General Hospital from 1 February 2018 to 31 January 2020.
A total of 1273 patients were evaluated for unmet palliative care needs; 685 patients received ED-PC and 588 received UC. The palliative care patients were more severely frail (AOR 2.217 (1.295-3.797), = 0.004), had functional deterioration with three ADLs (AOR 1.348 (1.040-1.748), = 0.024), biopsychosocial discomfort (AOR 1.696 (1.315-2.187), < 0.001), higher Taiwan Triage and Acuity Scale 1 ( = 0.024), higher in-hospital mortality (AOR 1.983 (1.540-2.555), < 0.001), were four times more likely to sign an DNR (AOR 4.536 (2.522-8.158), < 0.001), and were twice as likely to sign an DNR at admission (AOR 2.1331.619-2.811), < 0.001). Palliative care patients received less epinephrine (AOR 0.424 (0.265-0.678), < 0.001), more frequent withdrawal of an endotracheal tube (AOR 8.780 (1.122-68.720), = 0.038), and more narcotics (AOR1.675 (1.132-2.477), = 0.010). Palliative care patients exhibited lower 7-day, 30-day, and 90-day survival rates ( < 0.001). There was no significant difference in the hospital length of stay (LOS) (21.2 ± 26.6 vs. 21.7 ± 20.6, = 0.709) nor total hospital expenses (293,169 ± 350,043 vs. 294,161 ± 315,275, = 0.958).
Acute critically ill patients receiving palliative care were more frail, more critical, and had higher in-hospital mortality. Palliative care patients received less epinephrine, more endotracheal extubation, and more narcotics. There was no difference in the hospital LOS or hospital costs between the palliative and usual care groups. The synthesis of ED-PC is new but achievable with potential benefits to align care with patient goals.
在急诊科（ED-PC）中尽早实施姑息治疗有许多好处，包括通过最佳舒适措施和症状控制来提高生活质量。姑息治疗是否会影响重症监护病房的入院率、住院时间和资源利用情况，需要进一步调查。
确定接受姑息治疗（ED-PC）和常规护理（UC）的患者在住院特征、住院时间、生存和资源利用方面的差异。
回顾性观察性研究。
地点/参与者：我们纳入了 2018 年 2 月 1 日至 2020 年 1 月 31 日期间连续入住台北荣民总医院急诊重症监护病房的急性、危重患者。
共有 1273 例患者评估了未满足的姑息治疗需求；685 例患者接受了 ED-PC，588 例患者接受了 UC。姑息治疗患者的身体更加脆弱（优势比 2.217（1.295-3.797），P = 0.004），有三个日常生活活动能力（ADL）功能下降（优势比 1.348（1.040-1.748），P = 0.024），有生物心理社会不适（优势比 1.696（1.315-2.187），P < 0.001），台湾分诊和急症程度量表 1 评分较高（P = 0.024），住院死亡率较高（优势比 1.983（1.540-2.555），P < 0.001），签署 DNR 的可能性高 4 倍（优势比 4.536（2.522-8.158），P < 0.001），且入院时签署 DNR 的可能性高 2 倍（优势比 2.1331.619-2.811），P < 0.001）。姑息治疗患者接受的肾上腺素（优势比 0.424（0.265-0.678），P < 0.001）较少，更频繁地拔除气管内管（优势比 8.780（1.122-68.720），P = 0.038），以及更多的麻醉剂（优势比 1.675（1.132-2.477），P = 0.009）。姑息治疗患者的 7 天、30 天和 90 天生存率较低（P < 0.001）。住院时间（21.2 ± 26.6 与 21.7 ± 20.6，P = 0.709）和总住院费用（293,169 ± 350,043 与 294,161 ± 315,275，P = 0.958）均无显著差异。
接受姑息治疗的急性危重患者身体更脆弱，病情更严重，住院死亡率更高。姑息治疗患者接受的肾上腺素较少，气管内管拔除更多，麻醉剂使用更多。姑息治疗组和常规护理组在住院时间或住院费用方面无差异。ED-PC 的综合应用是新的，但可以实现，并且有可能使护理与患者的目标相匹配。
