Acute palliative care unit discharge outcomes: intensive versus non-intensive care transfers

OBJECTIVES: No studies examining clinical outcomes for patients transferred to an acute palliative care unit (APCU) from an intensive care unit (ICU) versus a non-ICU exist. The objectives were to determine the proportions and outcomes of patients being discharged alive from an APCU after being transferred from an ICU versus a non-ICU. METHODS: All patients transferred to our APCU from an ICU from 1 September 2021 to 31 August 2023 and an equally sized random sample of patients transferred from a non-ICU during the same period were identified. Demographics, clinical characteristics and outcomes were compared between the two groups. RESULTS: 400 patients (214 ICU and 186 non-ICU) were included (mean age, 62 years (SD, 14.3); 51.3% women; 63.8% in a relationship; 67.8% white). Non-ICU patients were more likely to be discharged alive than were ICU patients (32.8% (95% CI 26.5 to 39.8%) vs 22.4% (95% CI 17.4 to 28.5%); p=0.02). Of the 109 patients discharged from our APCU, most went either to hospice care at home (54.1%, n=59) or to inpatient hospice care (40.4%, n=44), and there was no difference in discharge location between the ICU and the non-ICU groups (p=0.93). On multivariable analysis, APCU mortality was more likely in the group overall among patients who were receiving oxygen via a high-flow nasal cannula (HFNC) (OR, 2.47 (1.25 to 4.90); p=0.01). CONCLUSIONS: Despite the APCU mortality in this cohort being high, 22.4% of patients transferring from the ICU were successfully discharged to the community. HFNC use at the time of APCU transfer was independently associated with increased odds of APCU mortality.