Inpatient Goals-of-Care Conversations Reduce Intensive Care Unit Transfers in High-Risk Patients

Amber Zimmer Deptola, Jessica Riggs

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Despite an aging population and an increase in the prevalence of chronic severe illness, many patients will not have end-of-life care discussions with their outpatient physicians. This very likely contributes to considerable hospital utilization toward the end of life, without any clear benefit. At our medical center, we noticed a very high rate of floor-to-intensive care unit (ICU) transfers for patients with life-limiting illness and poor prognosis. We initiated a quality assessment and improvement project aimed at increasing goals-of-care conversations for high-risk patients early in their hospital stays. Patients were identified using a risk assessment score combined with presence of life-limiting illness and alerting the inpatient attending physician to the patient’s severity of illness. Inpatient attending physicians were encouraged to expeditiously initiate and document goals-of-care discussions with their patients and families or to consult palliative care. Patient data were extracted retrospectively from high-risk patients prior to and during the intervention period. Analysis showed a significant increase in overall goals-of-care discussions and a significant reduction in floor-to-ICU transfers during initial admission. There was no change in mortality at 1 year, but there was a trend toward more in-home deaths for those patients who died within the year. Early inpatient goals-of-care conversations may reduce ICU utilization at index hospitalization and may reduce overall health-care utilization near the end of life.

Original languageEnglish
Pages (from-to)583-586
Number of pages4
JournalAmerican Journal of Hospice and Palliative Medicine
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2019

Keywords

  • chronic disease
  • health-care utilization
  • inpatient
  • outcome assessment
  • palliative care
  • patient care planning
  • veterans

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