A Randomized Allocation of Palliative Care Consultation in the Emergency Department Compared to Usual Practice

Wayne State University2 sites in 1 country120 target enrollmentJune 2016

ConditionsMultiple Organ Failure End Stage Cardiac Failure End Stage Chronic Obstructive Airways Disease Chronic Kidney Disease Stage 5 Hepatic Encephalopathy Sepsis Dementia Multiple Sclerosis Parkinson's Disease In-Hospital Cardiac Arrest Solid Organ Cancer

Overview

Phase: Not Applicable
Intervention: Not specified
Conditions: Multiple Organ Failure
Sponsor: Wayne State University
Enrollment: 120
Locations: 2
Primary Endpoint: The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
Last Updated: 9 years ago

Overview Investigators Eligibility Criteria Outcomes Sites Similar Trials

Overview

Brief Summary

A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg). Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.

Registry

clinicaltrials.gov

Start Date

June 2016

End Date

January 2017

Last Updated

9 years ago

Study Type

Interventional

Study Design

Parallel

Sex

All

Investigators

Sponsor

Wayne State University

Responsible Party

Principal Investigator

Robert Zalenski

Principle Investigator

Wayne State University

Eligibility Criteria

Inclusion Criteria

•Greater than or equal to 65 years old
•Treated in a resuscitation room for unstable vital signs or respiratory compromise
•One or more of the following:
•Advanced or metastatic solid organ cancer
•End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
•Suspected sepsis
•Advanced dementia, end-state multiple sclerosis or Parkinson's disease
•Status post cardiac arrest with coma (Glascow coma score \<7)
•Patient is from a skilled nursing facility

Exclusion Criteria

•Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
•Enrolled in hospice care prior to randomization
•A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
•Wearing a DNR bracelet
•Have been previously enrolled in this study

Outcomes

Primary Outcomes

The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg

Time Frame: 1 year

Secondary Outcomes

The proportion of billed CMS ACP-CPT codes in Ig vs. Cg(30 days from enrolled patients' hospital discharge)
Matches of care received to patient-specific preferences in Ig vs. Cg(1 year)
Patient/family satisfaction with care in Ig vs. Cg(Baseline)
Amount of hospice referrals in Ig vs. Cg(1 year)
Time to consultation in Ig vs. Cg groups(1 year)
Hospital total direct costs for the index visit in Ig vs. Cg(1 year)
Hospital and ICU length of stay in Ig vs. Cg(1 year)
Average days in hospice in Ig vs. Cg(1 year)
Hospital margin contribution for the index visit in Ig vs. Cg(1 year)