Embedded Palliative Care in the MICU

The Washington University

Status: Enrolling

Conditions: Quality of Life; Critical Illness; End of Life

Treatments: Other: Embedded Hospice and Palliative Care Practitioner; Other: Embedded Hospice and Palliative Care Practitioner (Group Effect); Other: None (Historical)

Study type: Interventional

Funder types: Other

Identifiers

NCT06574672

202406143

Details and patient eligibility

About

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.

Full description

The study goal is to determine whether an embedded palliative care practitioner in the medical ICU improves patient outcomes, palliative care/hospice utilization, and healthcare quality metrics. The medical ICUs included in this study are comprised of two geographically co-located units that provide care for medically complex patients from a large tertiary referral area. Palliative care services are currently available as a consultative service at the ICU clinicians' discretion for patients with palliative needs such as complex goals of care, advanced symptom management, or chronic critical illness. Under the current consultation model, palliative care consultation is requested in a minority of critically ill patients and consults occur on average 5-14 days after a patient's admission. Hospice services are similarly available on a consultative basis for patients that the primary team has determined are suitable for hospice, however, logistical limitations of hospice consultation may lead to delays in inpatient hospice transfers and home hospice discharges.

This study's intervention is to embed a palliative care/hospice practitioner within the medical ICUs as a dedicated palliative care and hospice consultant who will offer proactively triggered palliative care consultations early in a patient's ICU stay as well as immediate availability for standard-of-care palliative care and hospice consultations.

Enrollment: 2,600 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients admitted to the medical intensive care units at a tertiary referral center
• Patients must be at least 18 years of age

Exclusion criteria

• None

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

---

2,600 participants in 3 patient groups, including a placebo group

Prospective Hospice and Palliative Care Intervention

Experimental group

Description:

This arm comprises patients admitted to the specific medical intensive care unit in which the hospice and palliative care practitioner is currently active. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, followed by all patients admitted to both medical intensive care units during the second half of the intervention timeframe.

Treatment:

Other: Embedded Hospice and Palliative Care Practitioner

Prospective Standard of Care

Active Comparator group

Description:

This arm comprises patients admitted to the medical intensive care unit in which the hospice and palliative care practitioner is not currently active, but which may experience a group effect due to the study's ongoing enrollment and the practitioner's presence. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, prior to the practitioner becoming active in both intensive care units.

Treatment:

Other: Embedded Hospice and Palliative Care Practitioner (Group Effect)

Historical Controls

Placebo Comparator group

Description:

This arm comprises historical patients admitted to the medical intensive care units in the year prior to study enrollment.

Treatment:

Other: None (Historical)