A Retrospective Review of the Characteristics and Outcomes of Patients through an Integrated Palliative Care Model during the First Wave of the SARS-COV-2 Pandemic.

Abstract

<b><i>Background:</i></b> The COVID-19 pandemic created surges of rapidly deteriorating patients straining health care necessitating the evaluation of novel models of palliative care (PC) integration to reduce patient suffering and hospital strain. <b><i>Objective:</i></b> To evaluate an integrated PC model's effect on code status change. <b><i>Design:</i></b> This is an observational retrospective study. <b><i>Setting:</i></b> Urban quaternary referral center in the southeastern United States from April 6th to August 20th, 2020. <b><i>Patients:</i></b> All patients admitted to our medical intensive care unit and stepdown unit were diagnosed with COVID-19. <b><i>Measurements:</i></b> Code status change, multivariate regression on patient characteristics. <b><i>Results:</i></b> In total, 79.7% (98/123) patients were full code at admission. After PC consultation, 33.3% (41/123) patients remained full code, 13.0% (16/123) were do not resuscitate (DNR), and 53.6% (66/123) changed to DNR/do not intubate (DNI). An ordinal logistic model determined that consultation location (odds ratio [OR] 3.35, <i>p</i> = 0.017) and patient age (OR 1.09, <i>p</i> < 0.001) were predictive of code status change to DNR/DNI. <b><i>Conclusion:</i></b> Within an integrated PC model, PC consultation was associated with code status change. The effect of an integrated PC model warrants further study in comparison with a traditional PC model in a similar patient cohort.