Embedded Palliative Care in the MICU
NCT Number: NCT06574672
Status: RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Critical Illness|End of Life|Quality of Life
Interventions: OTHER: Embedded Hospice and Palliative Care Practitioner|OTHER: Embedded Hospice and Palliative Care Practitioner (Group Effect)|OTHER: None (Historical)
Sponsor: Washington University School of Medicine
Sex: ALL
Age: ADULT, OLDER_ADULT
Enrollment: 2600
Study Design: Allocation: RANDOMIZED|Intervention Model: SEQUENTIAL|Masking: NONE|Primary Purpose: SUPPORTIVE_CARE
Start Date: 2024-07-29
Completion Date: 2026-06
Locations: Barnes Jewish Hospital, Saint Louis, Missouri, 63110, United States

Summary:
The goal of this study is to investigate whether embedding a hospice and palliative care practitioner within a medical intensive care unit will improve patient outcomes and healthcare usage. The practitioner will work solely within the medical intensive care units and offer timely as well as proactive consultations based on clinical criteria and estimated mortality risk. The study team will compare patients seen by the practitioner to patients in an adjacent ICU and historical patients to determine whether patient care is improved by this intervention.

Primary Outcome Measures: ICU Length of Stay, Length of stay in any intensive care unit during the hospitalization, From date of enrollment until hospital discharge, assessed up to 1 year|Code Status De-escalation, Frequency of changes in code status to limited code or comfort measures only, From date of enrollment until hospital discharge, assessed up to 1 year
Secondary Outcome Measures: Presence of Advance Care Planning Documentation during Current Admission, Documentation of advance directives, limitations in life-sustaining treatments, or code status that is newly created during the active hospital admission, From date of enrollment until hospital discharge, assessed up to 1 year|Hospice Consultation, Frequency of Hospice consultations, From date of enrollment until hospital discharge, assessed up to 1 year|Hospice Enrollment, Frequency of discharge or transition to hospice during or immediately following the hospital stay, From date of enrollment until hospital discharge, assessed up to 1 year|Palliative Care Consultation, Frequency of Palliative Care consultations, From date of enrollment until hospital discharge, assessed up to 1 year|Time to change in code status, advance care planning documentation, palliative care consultation, and hospice consultation, Time in days to the first occurrence of the above outcomes, From date of enrollment until hospital discharge, assessed up to 1 year|Inpatient Hospice Duration, Days while patients are enrolled in inpatient hospice (GIP), From date of enrollment until hospital or hospice discharge, assessed up to 1 year|Location of discharge disposition, Discharge disposition to home, skilled nursing facility, long term acute care facility, inpatient rehabilitation, etc., From date of enrollment until hospital discharge, assessed up to 1 year|Hospital Length of Stay, Length of hospital stay in days, From date of enrollment until hospital discharge, assessed up to 1 year|Mortality Index (Vizient), Mortality index as calculated by Vizient, From date of enrollment until hospital discharge, assessed up to 1 year|Length of Stay Index (Vizient), Length of stay index as calculated by Vizient, From date of enrollment until hospital discharge, assessed up to 1 year|Operating cost in dollars, including departmental breakdown, Hospital operating cost for each patient, including departmental breakdown such as ICU, pharmacy, procedural, operating room, etc., Assessed six months following discharge|Mechanical Ventilation Duration, Days on mechanical ventilation, From date of enrollment until hospital discharge, assessed up to 1 year|Vasopressor Utilization, Days on vasopressors, From date of enrollment until hospital discharge, assessed up to 1 year|Hospital Mortality, Inpatient all-cause mortality, From date of enrollment until hospital discharge, assessed up to 1 year|30-Day Mortality, All-cause mortality within 30 days of hospital admission, Assessed 30 days after hospital admission|30-day Emergency Room Visit, Emergency Room encounter in the same healthcare system within 30 days of discharge, Assessed 30 days after hospital discharge|30-day Readmission, Hospital readmission in the same healthcare system within 30 days of discharge, Assessed 30 days after hospital discharge