School of Medicine and Health Sciences Poster Presentations

Title

The Effect of Early Palliative Intervention in Patients with Sepsis: A Retrospective Review

Document Type

Poster

Keywords

palliative; early; sepsis; advance directives

Publication Date

Spring 2017

Abstract

Background: Severe sepsis is the leading cause of in-hospital death and the most expensive condition treated in U.S. hospitals. Reassessing the goals of treatment with patients and their families with early palliative care consultations and advance care planning discussions has the potential to improve care and better utilize hospital resources.

Objectives: To evaluate if early vs. late advance care planning discussion with severe sepsis or septic shock patients or their caregivers affects hospital length of stay, disposition, ICU utilization, mortality, exposure to invasive procedures, and cost.

Methods: A retrospective chart review was performed for all patients over the age of 65 who presented to the emergency department fulfilling criteria for severe sepsis or septic shock in an urban university hospital. Data abstraction points included advance directive and advance care discussion documentation and outcomes such as length of stay, cost of hospitalization, in-hospital mortality, and use of invasive procedures. Patients were categorized into 4 groups: those with a palliative consult less than or equal to 4 days from admission, those greater than 4 days, those having a non-palliative physician discuss goals of care , and those having no palliative consult.

Results: Of 104 patients, 50 were female. 59% were African American and 31% were Caucasian. 62% resided in a private home. 61% had documentation of advance care directives in the chart. 46% of all sepsis patients had advance care planning discussions. 89% had co-morbidities that qualified them for palliative care yet 55% received no palliative consult. 77% of patients who received a palliative consult after 4 days were noted to have a length of stay of 16+ days. Each of the other groups was less than 25% with a length of stay of 16+ days. 67% of patients died after receiving a palliative consult after 4 days, compared to the other 3 groups where each was less than 40%. Hospital cost was over $150,000 in 89% of patients receiving a palliative consult after 4 days compared to the other 3 groups which were all under 25%.

Conclusion: The utility of early palliative consults and advance care discussions may be the greatest during the first four days of hospital admission as these patients had shorter stays and lower costs. Early palliative consults may present an opportunity to alter the trajectory of septic patients and improve overall outcomes.

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Creative Commons License
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Open Access

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Poster to be presented at GW Annual Research Days 2017.

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The Effect of Early Palliative Intervention in Patients with Sepsis: A Retrospective Review

Background: Severe sepsis is the leading cause of in-hospital death and the most expensive condition treated in U.S. hospitals. Reassessing the goals of treatment with patients and their families with early palliative care consultations and advance care planning discussions has the potential to improve care and better utilize hospital resources.

Objectives: To evaluate if early vs. late advance care planning discussion with severe sepsis or septic shock patients or their caregivers affects hospital length of stay, disposition, ICU utilization, mortality, exposure to invasive procedures, and cost.

Methods: A retrospective chart review was performed for all patients over the age of 65 who presented to the emergency department fulfilling criteria for severe sepsis or septic shock in an urban university hospital. Data abstraction points included advance directive and advance care discussion documentation and outcomes such as length of stay, cost of hospitalization, in-hospital mortality, and use of invasive procedures. Patients were categorized into 4 groups: those with a palliative consult less than or equal to 4 days from admission, those greater than 4 days, those having a non-palliative physician discuss goals of care , and those having no palliative consult.

Results: Of 104 patients, 50 were female. 59% were African American and 31% were Caucasian. 62% resided in a private home. 61% had documentation of advance care directives in the chart. 46% of all sepsis patients had advance care planning discussions. 89% had co-morbidities that qualified them for palliative care yet 55% received no palliative consult. 77% of patients who received a palliative consult after 4 days were noted to have a length of stay of 16+ days. Each of the other groups was less than 25% with a length of stay of 16+ days. 67% of patients died after receiving a palliative consult after 4 days, compared to the other 3 groups where each was less than 40%. Hospital cost was over $150,000 in 89% of patients receiving a palliative consult after 4 days compared to the other 3 groups which were all under 25%.

Conclusion: The utility of early palliative consults and advance care discussions may be the greatest during the first four days of hospital admission as these patients had shorter stays and lower costs. Early palliative consults may present an opportunity to alter the trajectory of septic patients and improve overall outcomes.