Embedded Palliative Care in the MICU
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorWashington University School of Medicine
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patients admitted to the medical intensive care units at a tertiary referral center
Patients must be at least 18 years of age
Disqualifiers
None
Trial design
Design model
Sequential
Treatments tested in this trial
Embedded Hospice and Palliative Care Practitioner
Other interventionThe hospice and palliative care practitioner will be embedded in one medical intensive care unit for the first half of the study timeframe, after which the practitioner will expand to both medical intensive care units. While active in a medical intensive care unit, the practitioner will proactively trigger palliative care consultations based on clinical criteria and estimated mortality risk, in addition to providing immediate availability for standard-of-care hospice or palliative care consultations.
Embedded Hospice and Palliative Care Practitioner (Group Effect)
Other interventionWhile the hospice and palliative care practitioner is active in one medical intensive care unit with respect to triggering consultations, the other medical intensive care unit can still utilize the practitioner's services for standard-of-care hospice or palliative care consultations.
None (Historical)
Other interventionThis control arm includes historical patients admitted to the medical intensive care units prior to the study's enrollment timeframe.
Treatment groups
2,600 Participants
are divided into 3 treatment groupsGroup A: Prospective Hospice and Palliative Care InterventionExperimental treatment 1 intervention
Group B: Prospective Standard of CareActive comparator 1 intervention
Group C: Historical ControlsPlacebo comparator 1 intervention
Trial outcomes
Primary outcomes
1
ICU Length of Stay
Length of stay in any intensive care unit during the hospitalization
Time frame
From date of enrollment until hospital discharge, assessed up to 1 year2
Code Status De-escalation
Frequency of changes in code status to limited code or comfort measures only
Time frame
From date of enrollment until hospital discharge, assessed up to 1 yearSecondary outcomes
1
Presence of Advance Care Planning Documentation during Current Admission
Documentation of advance directives, limitations in life-sustaining treatments, or code status that is newly created during the active hospital admission
Time frame
From date of enrollment until hospital discharge, assessed up to 1 year2
Hospice Consultation
Frequency of Hospice consultations
Time frame
From date of enrollment until hospital discharge, assessed up to 1 year3
Hospice Enrollment
Frequency of discharge or transition to hospice during or immediately following the hospital stay
Time frame
From date of enrollment until hospital discharge, assessed up to 1 year4
Palliative Care Consultation
Frequency of Palliative Care consultations
Time frame
From date of enrollment until hospital discharge, assessed up to 1 yearSponsors and contacts
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Source ClinicalTrials.gov