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Abstract Details

Does Early Initiation of Palliative Care (PC) Consult of Neurocritical Care Patients Provide Added Value?
Pain
P11 - Poster Session 11 (8:00 AM-9:00 AM)
6-001
Upstream palliative care improving transfer to comfort-care goal-concordant setting.

Patients receiving intensive care are at risk for unmet palliative care (PC) needs. Recent publications support PC for neurocritically ill patients. The aim of this study was to see if early initiation of PC consult affected transfer to comfort care goal concordant setting (CC-GCS; transfer to PCU) and Neuro ICU LOS in neurocritically ill patients.

Retrospective study of patients admitted to the neuro-critical unit at a comprehensive stroke center. Inclusion was based on having PC consultation. Early PC consults were defined as admission to consult ≤4 days. Primary outcome was early transition to CC-GCS. Secondary outcomes were total LOS, DNR, and documentation of GOC discussions. Differences in demographics, primary, and secondary outcomes were analyzed using chi-square analyses; p-values were computed using Mann-Whitney tests.

Of 380 patients, average age was 70.6 years, 48% were male, mean Charlson Comorbidity Index was 5.91 (SD=3.02), 80% had a DNR on file, 59% had GOC documentation, 58.7% expired and 3.4% were discharged to hospice. Principal diagnoses were intracranial hemorrhage (41.2%), cerebrovascular accident (18.5%), and cancer (9.0%).

Mean time to transfer to CC-GCS between early (1.37 days) and late (2.03 days) consult groups did differ, but this was not statistically significant (U=14481, p>0.1). No significant differences were found across all secondary outcomes (p>0.1) except for ICU LOS. Patients who received early consults (median=5.19) spent significantly fewer days in the ICU compared to those who received late consults (median=14.03), p<0.001. To account for LOS being artificially shortened due to patients expiring, a survival analysis was conducted and showed similar proportions of event occurrences regardless of consult group(Log-rank z=-0.99, p>0.1). 
Early PC consultation for patients admitted to a neurocritical care unit may provide added value by facilitating transition to comfort care GCS and decreasing overall ICU LOS.
Authors/Disclosures

PRESENTER
No disclosure on file
Adriana Calosso, NP No disclosure on file
No disclosure on file
Jeffrey M. Katz, MD (North Shore University Hospital) Dr. Katz has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Katz Medical Consulting. The institution of Dr. Katz has received research support from Medtronic.
No disclosure on file
No disclosure on file
No disclosure on file