Please use this identifier to cite or link to this item: https://repositorio.bahiana.edu.br:8443/jspui/handle/bahiana/3024
Title: Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis
Other Titles: Revista Brasileira de Terapia Intensiva
Authors: Mendes, Ana Verena Almeida
Ramos, João Gabriel Rosa
Tourinho, Fernanda Correia
Borrione, Patrícia
Azi, Paula
Andrade, Tuanny
Costa, Vanessa
Reis, Zan
Batista, Paulo Benigno Pena
Keywords: Palliative care; Resuscitation orders; Patient care planning; Interrupted time series analysis; Intensive care units
Issue Date: 17-Jan-2018
Abstract: Objective:To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations. Methods: Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program. Results: We analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001). Conclusion: The implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.
URI: http://www7.bahiana.edu.br//jspui/handle/bahiana/3024
ISSN: 308-316
Appears in Collections:Artigos Completos Publicados em Periódicos

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