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A Randomized Trial of Palliative Care Discussions Linked to an Automated Early Warning System Alert

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Abstract

Objective:

To determine whether an Early Warning System could identify patients wishing to focus on palliative care measures.

Design:

Prospective, randomized, pilot study.

Setting:

Barnes-Jewish Hospital, Saint Louis, MO (January 15, 2015, to December 12, 2015).

Patients:

A total of 206 patients; 89 intervention (43.2%) and 117 controls (56.8%).

Interventions:

Palliative care in high-risk patients targeted by an Early Warning System.

Measurements and Main Results:

Advanced directive documentation was significantly greater prior to discharge in the intervention group (37.1% vs 15.4%; p < 0.001) as were first-time requests for advanced directive documentation (14.6% vs 0.0%; p < 0.001). Documentation of resuscitation status was also greater prior to discharge in the intervention group (36.0% vs 23.1%; p = 0.043). There was no difference in the number of patients requesting a change in resuscitation status between groups (11.2% vs 9.4%; p = 0.666). However, changes in resuscitation status occurred earlier and on the general medicine units for the intervention group compared to the control group. The number of patients transferred to an ICU was significantly lower for intervention patients (12.4% vs 27.4%; p = 0.009). The median (interquartile range) ICU length of stay was significantly less for the intervention group (0 [0–0] vs 0 [0–1] d; p = 0.014). Hospital mortality was similar (12.4% vs 10.3%; p = 0.635).

Conclusions:

This study suggests that automated Early Warning System alerts can identify patients potentially benefitting from directed palliative care discussions and reduce the number of ICU transfers.

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