Lead author May Hua, MD, MS, an assistant professor of anesthesiology at Columbia University College of Physicians and Surgeons, and her colleagues conducted a study wherein data from 51 New York hospitals that implemented or did not implemented palliative care was analyzed. The objective of this study was to find out whether palliative care services decreased the use of intensive care at the end-of-life for hospitalized patients.
The investigators included at least 18-year-old patients who died in 1 of the 51 New York hospitals during terminal hospitalization. 24 had a palliative care program amongst the hospitals included in the study, and 27 reported never having one. Implementation of palliative care at a hospital was associated with a 10% reduction in ICU use for patients who died during hospitalization, according to study findings.
The primary outcome was whether the patient received intensive care in the ICU. Additional outcomes included the length of hospital stay, use of dialysis, and days in the ICU and use of mechanical ventilation. Overall, 73,370 patients died while hospitalized during the study period. More than half (51.3%) of the patients received care in hospitals with palliative care programs, while 48.7% were in a hospital without the implementation of such programs.ICU admission during terminal hospitalization was more frequent for patients cared for in hospitals with palliative code (50.9%) than those in hospitals that did not (46%).
After implementing a palliative care program, patients who had a care in a hospital were less likely to receive intensive care than those in the same hospital pre-implementation program. There was a significant decrease when the investigators compared the findings with those hospital patients who never had palliative care.
Although introducing palliative care services could lead to cost savings in health care and decrease the severity of end-of-life medical care, health care providers should not associate end-of-life care quality with less intensive care, the researchers wrote.