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Quality Improvement in Palliative Care Consultation in a Medical ICU

This study is not yet open for participant recruitment.
See Contacts and Locations
Verified July 2017 by Marin Kollef, Washington University School of Medicine
Sponsor:
Information provided by (Responsible Party):
Marin Kollef, Washington University School of Medicine
ClinicalTrials.gov Identifier:
NCT03210116
First received: June 25, 2017
Last updated: July 3, 2017
Last verified: July 2017
  Purpose
A quality improvement project compares automatic palliative care consultation compared to standard of care in the medical intensive care unit (ICU). The study will assess if the intervention leads to an increased proportion of clearly delineated goals of care and quality of life and examine if this intervention leads to decreased length of days in the ICU, Hospital, and on mechanical ventilation.

Condition Intervention
Palliative Care Quality Improvement Other: Palliative Care

Study Type: Observational
Study Design: Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Quality Improvement in Palliative Care Consultation in a Medical Intensive Care Unit

Resource links provided by NLM:


Further study details as provided by Marin Kollef, Washington University School of Medicine:

Primary Outcome Measures:
  • ICU Length of Stay [ Time Frame: Through study completion, an average of 1 year ]
  • Hospital length of stay [ Time Frame: Through study completion, an average of 1 year ]
  • Cardiopulmonary resuscitation (CPR) performed [ Time Frame: Through study completion, an average of 1 year ]
  • Days on Mechanical Ventilation [ Time Frame: Through study completion, an average of 1 year ]

Secondary Outcome Measures:
  • Transition to comfort care or discharge to hospice [ Time Frame: Through study completion, an average of 1 year ]
  • Total hospital stay cost [ Time Frame: Through study completion, an average of 1 year ]

Estimated Enrollment: 400
Anticipated Study Start Date: July 2017
Estimated Study Completion Date: August 2018
Estimated Primary Completion Date: April 2018 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Standard of Care
Palliative Care Consultation
Early palliative care consultation within 24 to 48 hours after admission
Other: Palliative Care
Palliative Care Consultation

Detailed Description:
  • The medical intensive care unit will be split into two groups, assigned as either automatic palliative care consultation or standard of care.
  • A palliative care screening tool will be used to determine if a newly admitted patient is eligible for palliative care consultation. For patients in the standard of care group, medical records will be reviewed.
  • The two medical ICU groups will be crossed over to the after 3 months for a total of 6 months of study.
  • Participants will be followed through his or her hospitalization.
  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Medically complex patients with acute, chronic, or acute on chronic medical illnesses requiring a high level of care in the intensive care unit
Criteria

Inclusion Criteria:

  • Admitted to ICU in the last 24 hours

    • Admitted from skilled nursing facility (SNF), long term acute care (LTAC) facility, long term ventilator care (vent LTC) unit, or home care with private duty nursing with activity of daily living (ADL) dependencies
    • End-stage dementia, amyotrophic lateral sclerosis, Parkinson's, multiple Sclerosis
    • Advanced or Metastatic Cancer
    • Cardiac or respiratory arrest with neurological compromise
    • Multi-organ system failure (more than 2 organ failures)
    • Known diagnosis of end stage organ disease including cirrhosis, end-stage renal disease, congestive heart failure New York Heart Association > III, chronic obstructive pulmonary disease on home O2
    • Shock requiring > 6 hours of vasopressors or inotropes
    • Acute respiratory failure requiring intubation or non invasive positive pressure ventilation
    • Admitted to ICU with hospital length of stay of more than 5 days or ICU readmission with the same diagnosis in 30 days.

Exclusion Criteria:

  • Solid organ or stem cell transplant patients
  • Patients who do not speak English if interpreter is unavailable
  • Patients without capacity to participate in palliative care discussions without a surrogate available
  • Patient or patient surrogate refusal of palliative care consultation
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT03210116

Contacts
Contact: Jessica Ma 314-362-8065 maje@wustl.edu

Locations
United States, Missouri
Barnes Jewish Hospital Active, not recruiting
Saint Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
  More Information

Publications:

Responsible Party: Marin Kollef, Professor, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT03210116     History of Changes
Other Study ID Numbers: 201705046
Study First Received: June 25, 2017
Last Updated: July 3, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

ClinicalTrials.gov processed this record on July 24, 2017