Early Palliative Care Consultation for Patients Requiring Extracorporeal Membrane Oxygenation

BACKGROUND: Patients receiving extracorporeal membrane oxygenation have high mortality rates, yet integrating palliative care for this population is not standardized. LOCAL PROBLEM: This quality improvement project evaluated whether early palliative care consultation for adult patients receiving extracorporeal membrane oxygenation would reduce the time to consultation and shorten cardiothoracic intensive care unit and overall hospital stays. METHODS: An extracorporeal membrane oxygenation rounding checklist was introduced into daily interprofessional rounds to guide integration of palliative care. The intervention was structured according to the Donabedian model of assessing care quality. The Donabedian model is based on improving patient outcomes by improving clinical processes. Retrospective and prospective length-of-stay data were collected and analyzed. RESULTS: Among 60 patients (mean age, 54 years; 62% male; 58% White), the mean time from admission to palliative care consultation decreased from 10.8 days to 6.1 days (P = .18). The mean intensive care unit stay decreased from 26 days to 22.8 days (P = .64). Total hospital stay decreased from 31 days to 27.3 days (P = .58). CONCLUSION: Although not statistically significant, the findings are clinically and economically meaningful, suggesting that early palliative care consultation can shorten intensive care unit and hospital stays for patients receiving extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation checklist was easy to use, requiring minimal training. Full implementation was achieved in less than 7 days, making the intervention replicable across health care facilities. Further research with larger samples is needed to better understand the impact of palliative care in this population.