Patterns of palliative care service consultation in a sample of critically ill ICU patients at high risk of dying

- We described patterns of palliative care consultation among critically ill ICU patients who were at high risk of dying and/or who died.
- Subspecialty palliative care consultations were late and infrequent.
- The majority of consultations were made for clarification of goals of care.
- New paradigms are needed to deliver timely palliative care to more patients.

ObjectiveDescribe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying.BackgroundPatients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes.MethodsFrom a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation.ResultsAbout half (773/1440 [54%]) were at high risk of dying or died, 73 (9.4%) of whom received palliative care consultation. On average, referral occurred after 62% of the ICU stay had elapsed. Primary reason for consult was clarification of goals of care (52/73 [72.2%]).ConclusionsAmong MV ICU patients at high risk of dying, palliative care service consultation occurs late and infrequently, suggesting a role for earlier palliative care.