The Real-World Effect of Early Screening for Palliative Care Criteria in a Medical Intensive Care Unit: An Instrumental Variable Analysis

• DOI: 10.1513/annalsats.202407-702oc
• Publication Date: 2024-10-23T13:50:02Z
• Authors: Chad H. Hochberg; Rebecca A. Gersten; Khyzer B. Aziz; Margaret D. Krasne; Li Yan; Alison E. Turnbull; Daniel Brodie; Michelle Churchill; Danielle J. Doberman; Theodore J. Iwashyna; David N. Hager
• Keywords: Instrumental variable

Rationale: Early identification of intensive care unit (ICU) patients likely to benefit from specialist palliative could reduce the time such spend in ICU receiving inconsistent with their goals. Objectives: To evaluate real-world effects early screening for criteria a medical ICU. Methods: We performed retrospective cohort study adults admitted using causal inference approach instrumental variable analysis. The intervention consisted admissions trigger conditions and, if present, offering consultation, which be accepted or declined by evaluated use pre and postimplementation cohorts year before after implementation began (October 2022). In cohort, we compared those who received versus not. then estimated effect on primary outcome days do-not-resuscitate (DNR) code status discharge, death without DNR order placed at 99th percentile discharge distribution. Secondary outcomes included: order, hospital lengths stay, hospice mortality metrics. address unmeasured confounding, used two-stage least-squares variables instrument, predicts screening, comprised weekend weekday admission number meeting patient's Days 1 2. Results: Among 1,282 admissions, 626 (45%) 398 (28%) specialty consultation. receipt was higher not (17% vs. 1%; P < 0.001), overall (28% 15%; 0.001). there were no statistically significant (15% relative increase; 95% confidence interval, -11% +48%) other secondary outcomes. Conclusions: Despite significantly increased evidence that affected DNR/ICU