Embedded Palliative Care in the MICU
- Registration Number
- NCT06574672
- Lead Sponsor
- Washington University School of Medicine
- Brief Summary
The goal of this study is to investigate whether embedding a hospice and palliative care practitioner within a medical intensive care unit will improve patient outcomes and healthcare usage. The practitioner will work solely within the medical intensive care units and offer timely as well as proactive consultations based on clinical criteria and estimated mo...
- Detailed Description
The study goal is to determine whether an embedded palliative care practitioner in the medical ICU improves patient outcomes, palliative care/hospice utilization, and healthcare quality metrics. The medical ICUs included in this study are comprised of two geographically co-located units that provide care for medically complex patients from a large tertiary r...
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 2600
- Patients admitted to the medical intensive care units at a tertiary referral center
- Patients must be at least 18 years of age
- None
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Prospective Standard of Care Embedded Hospice and Palliative Care Practitioner (Group Effect) This arm comprises patients admitted to the medical intensive care unit in which the hospice and palliative care practitioner is not currently active, but which may experience a group effect due to the study's ongoing enrollment and the practitioner's presence. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, prior to the practitioner becoming active in both intensive care units. Prospective Hospice and Palliative Care Intervention Embedded Hospice and Palliative Care Practitioner This arm comprises patients admitted to the specific medical intensive care unit in which the hospice and palliative care practitioner is currently active. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, followed by all patients admitted to both medical intensive care units during the second half of the intervention timeframe. Historical Controls None (Historical) This arm comprises historical patients admitted to the medical intensive care units in the year prior to study enrollment.
- Primary Outcome Measures
Name Time Method ICU Length of Stay From date of enrollment until hospital discharge, assessed up to 1 year Length of stay in any intensive care unit during the hospitalization
Code Status De-escalation From date of enrollment until hospital discharge, assessed up to 1 year Frequency of changes in code status to limited code or comfort measures only
- Secondary Outcome Measures
Name Time Method Vasopressor Utilization From date of enrollment until hospital discharge, assessed up to 1 year Days on vasopressors
30-Day Mortality Assessed 30 days after hospital admission All-cause mortality within 30 days of hospital admission
Presence of Advance Care Planning Documentation during Current Admission From date of enrollment until hospital discharge, assessed up to 1 year Documentation of advance directives, limitations in life-sustaining treatments, or code status that is newly created during the active hospital admission
Hospice Enrollment From date of enrollment until hospital discharge, assessed up to 1 year Frequency of discharge or transition to hospice during or immediately following the hospital stay
Time to change in code status, advance care planning documentation, palliative care consultation, and hospice consultation From date of enrollment until hospital discharge, assessed up to 1 year Time in days to the first occurrence of the above outcomes
Location of discharge disposition From date of enrollment until hospital discharge, assessed up to 1 year Discharge disposition to home, skilled nursing facility, long term acute care facility, inpatient rehabilitation, etc.
Length of Stay Index (Vizient) From date of enrollment until hospital discharge, assessed up to 1 year Length of stay index as calculated by Vizient
30-day Emergency Room Visit Assessed 30 days after hospital discharge Emergency Room encounter in the same healthcare system within 30 days of discharge
Hospice Consultation From date of enrollment until hospital discharge, assessed up to 1 year Frequency of Hospice consultations
Palliative Care Consultation From date of enrollment until hospital discharge, assessed up to 1 year Frequency of Palliative Care consultations
Hospital Length of Stay From date of enrollment until hospital discharge, assessed up to 1 year Length of hospital stay in days
Mortality Index (Vizient) From date of enrollment until hospital discharge, assessed up to 1 year Mortality index as calculated by Vizient
Hospital Mortality From date of enrollment until hospital discharge, assessed up to 1 year Inpatient all-cause mortality
Inpatient Hospice Duration From date of enrollment until hospital or hospice discharge, assessed up to 1 year Days while patients are enrolled in inpatient hospice (GIP)
Operating cost in dollars, including departmental breakdown Assessed six months following discharge Hospital operating cost for each patient, including departmental breakdown such as ICU, pharmacy, procedural, operating room, etc.
Mechanical Ventilation Duration From date of enrollment until hospital discharge, assessed up to 1 year Days on mechanical ventilation
30-day Readmission Assessed 30 days after hospital discharge Hospital readmission in the same healthcare system within 30 days of discharge
Trial Locations
- Locations (1)
Barnes Jewish Hospital
🇺🇸Saint Louis, Missouri, United States