Impact of an Embedded Palliative Care and Hospice Practitioner in the Medical ICU

What this Trial Is About

This research aims to assess whether placing a hospice and palliative care practitioner directly inside a medical intensive care unit (ICU) improves patient outcomes, use of palliative and hospice care, and overall healthcare quality. The study focuses on medically complex patients admitted to two nearby medical ICUs at a large referral center. Currently, palliative care is provided only when requested by ICU clinicians, often late in the patient's stay, which can delay needed support and hospice transfers. The study compares three groups: patients in an ICU with the embedded practitioner who proactively offers timely palliative care consultations based on clinical criteria and mortality risk; patients in a second ICU where the practitioner is not embedded but available for standard consultations; and historical patients treated before the study began. Initially, the practitioner works in one ICU and later expands to both units to provide early and on-demand palliative and hospice consultations. Participants will be admitted to one of the medical ICUs during the study period. Researchers will track many outcomes including ICU and hospital length of stay, code status changes, advance care planning documentation, hospice and palliative care consultations and enrollment, mortality, readmissions, and healthcare costs up to one year after enrollment. These measures will help determine if embedding the practitioner improves care quality and patient experiences in the ICU setting.

Embedded Palliative Care in the MICU