Opportunities to Improve Palliative Care Delivery in Trauma Critical Illness.
Lindsay Haines, Wei Wang, Michael Harhay and 3 others
PMID 34467775WHAT IT FOUND
Palliative care consults and goals-of-care notes were rarely documented in trauma ICU patients, including high-risk groups, and often occurred late.
Key findings
01Only 111 patients (8.5%) received either a palliative care consult order or an advance care planning note among 1309 eligible trauma ICU admissions.
02Palliative care consult order rates were 8.7% among patients 55 years or older, 12.8% among patients with at least one pre-injury life-limiting comorbidity, 9.3% among patients with Injury Severity Score over 15, and 4.5% among Black patients.
03Among decedents who survived at least 72 hours, 31 (70.5%) received any palliative care, but 13 (41.9%) received their first palliative care within the last 72 hours of admission.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one level one trauma center, so its palliative care patterns may not match other hospitals. It was retrospective and had no control group, so it cannot show whether palliative care helped or harmed patients. It counted consult orders and designated advance care planning notes, so it may miss palliative care documented elsewhere or count orders that were not completed. It did not assess symptom control, psychosocial support, or the content and quality of goals-of-care conversations.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that early palliative care improves trauma outcomes. This study only counted palliative care orders and goals-of-care notes; it did not compare outcomes or show why care was delayed.