In 2011, sepsis accounted for more than $20 billion (5.2%) of total US hospital costs. The CDC estimates that hospitalizations for sepsis or septicemia increased from 621,000 to 1,141,000 in 2000 and 2008 respectively. Severe sepsis has an in-hospital mortality rate of 28.6-37.7%, and those who survive may face a difficult recovery including long-term physical, psychological, and cognitive disabilities.
Per the 2012 Surviving Sepsis Campaign Guidelines, Goals of Care (GOC) were identified as an important focal point within the supportive therapies. The committee recommended a discussion of GOC and prognosis with patients and families, incorporating GOC into treatment and end-of-life care planning, utilizing palliative care principles where appropriate, and addressing GOC early on, but no later than within 72 hours of ICU admission. This study examined the impact of palliative care consultation (PCC) in patients admitted to the ICU with severe sepsis/septic shock.
Methods:
We performed a case-control retrospective chart review of 237 severe sepsis/septic shock patients admitted to a 250-bed community teaching hospital with a 19 bed ICU between January 2013 and June 2015. Of the 237 patients, 38 received a PCC (case) and were matched to 38 that did not (control) for a total of 76 patients. Study variables included age, sex, admitting diagnoses, length of stay (LOS), length of ICU stay (LOSICU), code status on admission/discharge, PCC, length of time to PCC, number of procedures, in hospital mortality, and discharge location.
Results:
PCC group had significantly longer LOS (8.6 vs 3.8 days p=0.002), LOSICU (12.7 vs 8.2 days p=0.019), and more procedures (14.3 vs 8.9 p =0.001). There was a marginally significant correlation between mortality and likelihood of PCC (39.5% vs 23.7% p=0.108). A subgroup analysis examining timeliness of PCC revealed that 17 of 38 patients had a PCC within the recommended 72 hour time frame. These patients had significantly lower LOS (8.5 vs 16 days p=0.008), lower LOSICU (6 vs 10.8 days p=0.047), and fewer procedures (11.8 vs 16.3 p=0.031).
Conclusions:
Patients for whom a PCC was requested had significantly increased LOS, LOSICU and number of procedures, likely denoting identification by ICU staff of highest risk patients within study population. Notably however, patients who received a PCC within 72 hours had significantly lower LOS, LOSICU, and fewer procedures compared to those with delayed PCC. This finding lends support to the potential benefit of complying with guideline-based timeliness of PCC.