Evidence map›Paper›PMID 36584736›Full record

ArticleJournal of pain and symptom management2023

Lessons Learned from an Embedded Palliative Care Model in the Medical Intensive Care Unit.

Ankita Mehta, Priya Krishnasamy, Emily Chai, Samuel Acquah, Joshua Lasseigne, Amy Newman, Li Zeng, Laura P Gelfman

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of pain and symptom management, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
2.6field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Guideline
  2. Article
  3. Review
  4. Article
  5. Review
  6. Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Ankita MehtaBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: ankita.mehta@mssm.edu.
Priya KrishnasamyBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Emily ChaiBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Samuel AcquahDivision of Pulmonary (S.A.), Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Joshua LasseigneBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Amy NewmanBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Li ZengBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Laura P GelfmanBrookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research Education and Clinical Center (L.P.G.), James J. Peters VA Medical Center, Bronx, NY, USA.
Icahn School of Medicine at Mount Sinai · USGeriatric Research Education and Clinical Center · US

Funding

Conduits: Mount Sinai Health System Translational Science HubUL1TR004419 · NCATS · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI Rosalind J Wright · 2022 to 2026
$46.4M
Residing in the Community with Dementia at the End of Life: Understanding Hospice Use and Residential SettingP30AG028741 · NIA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI MELISSA Diane ALDRIDGE, R. Sean Morrison · 2010 to 2026
$21.9M
Goals of Care Discussions in Older Adults with Heart Failure and Their CaregiversK23AG049930 · NIA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI GELFMAN, LAURA PILAR · 2016 to 2022
$816k
NCATS NIH HHS UL1 TR004419NIA NIH HHS K23 AG049930NIA NIH HHS P30 AG028741
6 · The paper itself

Abstract

objectiveTo describe a physician (MD) and registered nurse (RN) led palliative care consultation team embedded in the medical intensive care unit (MICU). To compare patterns of palliative care consultation, and rates of goals of care documentation and in-ICU mortality before and after the implementation of the embedded team. CONTEXT: By embedding MD/RN palliative care team in the MICU, more critically ill patients with unmet palliative care needs could receive an earlier palliative care consultation.

methodsIn a retrospective cohort study of patients admitted to the MICU who received a palliative care consultation, we compared sociodemographic and clinical characteristics of patients who received a referral-based consultation (01/01/2019-06/30/2019) and those who received an embedded MD/RN consult (09/01/2019-02/28/2020). Using the electronic health record data, we compared palliative care consultation characteristics, rates of documentation of medical decision-maker and goals of care, and percentage of in-ICU mortality between the referral group and the embedded group.

resultsIn a six-month period, 169 MICU patients received an embedded consultation, as compared to 52 MICU patients who received a referral-based consultation. As compared to the referral-based period, those patients who received an embedded consult were seen significantly earlier in hospitalization (median number of days from hospital admission to consult: 10 days [pre] vs. 3 days [embedded], P<0.001), more likely to have documentation of medical decision-makers (40% [pre] vs. 66% [embedded], P=0.002) and goals of care (37% [pre] vs. 71% [embedded], P<0.001) and less likely to die in the hospital (75% [pre] vs. 44% [embedded], P<0.001).

conclusionsAfter embedding a palliative care MD/RN team into the MICU, patients received earlier palliative care consultation, were more likely to have medical decision-maker and goals of care documented, and less likely to die in the hospital. Future work will examine how to adapt this model to other ICUs to improve palliative care access for critically ill patients broadly.

Indexed as

Critical IllnessPalliative CareHospitalizationHumansIntensive Care UnitsReferral and ConsultationRetrospective StudiesEmbeddedIntensive care unitModel of deliveryPalliative care

Identifiers

PMID36584736
PMCPMC10258731
OpenAlexW4312208394

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.