The Impact of Early Palliative Care Consultation on Length of Stay for Critically Ill Adults in the Intensive Care Unit

Palliative Care Consultation (PCC) is an established intervention that prioritizes goals of care conversations and assists patients with complex medical decision-making. Evidence suggests that PCC can reduce the amount of non-goal concordant care patients receive such as fewer invasive procedures, less mechanical ventilation, and quicker transition to hospice and referral to appropriate resources, if that aligns with patient wishes. This results in decreased resource utilization, reduced anxiety for patients and their family members, and decreased moral distress for the health care team. Studies generally agree that benefits of PCC are greater the quicker the time to intervention, but results are mixed regarding hospital and intensive care unit (ICU) length of stay (LOS). LOS is a surrogate marker for goal-concordant care, and shorter LOS has been associated with decreased health care costs. This systematic literature review seeks to clarify the effects of early PCC versus standard PCC on length of stay. From an extensive search of CINAHL, EMBASE, Scopus, and PubMed, 17 articles met criteria to be reviewed. These articles include 2 randomized controlled trials (RCTs), 6 prospective cohort studies, and 9 retrospective cohort studies. Nine studies found statistically significant results linking early PCC with shorter length of stay. These results indicate that a change in practice could be considered given the multiple positive outcomes associated with early PCC. Further research is recommended with larger sample sizes across multiple institutions to improve generalizability of these initial findings, and to examine the different modalities of implementing early PCC into existing ICU workflows.