Clinical trial NCT02858778: Timing of Acute Palliative Care Consultation in Critically Ill Patients
Official title: A Randomized Allocation of Palliative Care Consultation in the Emergency Department Compared to Usual Practice
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Multiple Organ Failure
End Stage Cardiac Failure
End Stage Chronic Obstructive Airways Disease
Chronic Kidney Disease Stage 5
Hepatic Encephalopathy
Sepsis
Dementia
Multiple Sclerosis
Parkinson's Disease
In-Hospital Cardiac Arrest
Solid Organ Cancer
Keywords: Palliative Care
Emergency Department
Lead sponsor: Wayne State University
Sponsor class: OTHER
Collaborators: name: Blue Cross Blue Shield of Michigan Foundation
First posted: 2016-08-08
Enrollment: 120
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg). Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.


Eligibility criteria: Inclusion Criteria:

* Greater than or equal to 65 years old
* Treated in a resuscitation room for unstable vital signs or respiratory compromise
* One or more of the following:
* Advanced or metastatic solid organ cancer
* End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
* Suspected sepsis
* Advanced dementia, end-state multiple sclerosis or Parkinson's disease
* Status post cardiac arrest with coma (Glascow coma score \<7)
* Patient is from a skilled nursing facility

Exclusion Criteria:

* Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
* Enrolled in hospice care prior to randomization
* A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
* Wearing a DNR bracelet
* Have been previously enrolled in this study

Primary outcomes:
measure: The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
timeFrame: 1 year
Secondary outcomes:
measure: The proportion of billed CMS ACP-CPT codes in Ig vs. Cg
timeFrame: 30 days from enrolled patients' hospital discharge
measure: Matches of care received to patient-specific preferences in Ig vs. Cg
timeFrame: 1 year
measure: Patient/family satisfaction with care in Ig vs. Cg
timeFrame: Baseline
measure: Amount of hospice referrals in Ig vs. Cg
timeFrame: 1 year
measure: Hospital total direct costs for the index visit in Ig vs. Cg
timeFrame: 1 year
measure: Hospital and ICU length of stay in Ig vs. Cg
timeFrame: 1 year
measure: Average days in hospice in Ig vs. Cg
timeFrame: 1 year
measure: Hospital margin contribution for the index visit in Ig vs. Cg
timeFrame: 1 year
measure: Time to consultation in Ig vs. Cg groups
timeFrame: 1 year
Other outcomes:
Locations:
city: Detroit
country: United States
facility: Detroit Medical Center Detroit Receiving Hospital
state: Michigan
city: Detroit
country: United States
facility: Detroit Medical Center Sinai Grace Hospital
state: Michigan
Study officials:
affiliation: Wayne State University
name: Robert Zalenski, M.D., M.A.
role: PRINCIPAL_INVESTIGATOR
References: