Skip to main content
OpenTrials
Recruiting

NCT Number: NCT06574672

Embedded Palliative Care in the MICU

The goal of this study is to investigate whether embedding a hospice and palliative care practitioner within a medical intensive care unit will improve patient outcomes and healthcare usage. The practitioner will work solely within the medical intensive care units and offer timely as well as proactive consultations based on clinical criteria and estimated mortality risk. The study team will compare patients seen by the practitioner to patients in an adjacent ICU and historical patients to determine whether patient care is improved by this intervention.

Recruiting

Interested in participating?

Request Info

Key information

Conditions

Critical Illness Death Disease Attributes End of Life Pathologic Processes Pathological Conditions, Signs and Symptoms Quality of Life

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Barnes Jewish Hospital

St Louis, Missouri, 63110, United States

Location status: Recruiting

Location contact

Stephen Chi, MD

CONTACT

[email protected]

314-273-6176

Stephen Chi, MD

PRINCIPAL_INVESTIGATOR

About this study

The study goal is to determine whether an embedded palliative care practitioner in the medical ICU improves patient outcomes, palliative care/hospice utilization, and healthcare quality metrics. The medical ICUs included in this study are comprised of two geographically co-located units that provide care for medically complex patients from a large tertiary referral area. Palliative care services are currently available as a consultative service at the ICU clinicians' discretion for patients with palliative needs such as complex goals of care, advanced symptom management, or chronic critical illness. Under the current consultation model, palliative care consultation is requested in a minority of critically ill patients and consults occur on average 5-14 days after a patient's admission. Hospice services are similarly available on a consultative basis for patients that the primary team has determined are suitable for hospice, however, logistical limitations of hospice consultation may lead to delays in inpatient hospice transfers and home hospice discharges.

This study's intervention is to embed a palliative care/hospice practitioner within the medical ICUs as a dedicated palliative care and hospice consultant who will offer proactively triggered palliative care consultations early in a patient's ICU stay as well as immediate availability for standard-of-care palliative care and hospice consultations.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients admitted to the medical intensive care units at a tertiary referral center
  • Patients must be at least 18 years of age

Exclusion criteria

  • None

Treatment and study plan

Embedded Hospice and Palliative Care Practitioner

Other

The hospice and palliative care practitioner will be embedded in one medical intensive care unit for the first half of the study timeframe, after which the practitioner will expand to both medical intensive care units. While active in a medical intensive care unit, the practitioner will proactively trigger palliative care consultations based on clinical criteria and estimated mortality risk, in addition to providing immediate availability for standard-of-care hospice or palliative care consultations.

Embedded Hospice and Palliative Care Practitioner (Group Effect)

Other

While the hospice and palliative care practitioner is active in one medical intensive care unit with respect to triggering consultations, the other medical intensive care unit can still utilize the practitioner's services for standard-of-care hospice or palliative care consultations.

None (Historical)

Other

This control arm includes historical patients admitted to the medical intensive care units prior to the study's enrollment timeframe.

Primary outcomes

  1. ICU Length of Stay

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Length of stay in any intensive care unit during the hospitalization

  2. Code Status De-escalation

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Frequency of changes in code status to limited code or comfort measures only

Secondary outcomes

  1. Presence of Advance Care Planning Documentation during Current Admission

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Documentation of advance directives, limitations in life-sustaining treatments, or code status that is newly created during the active hospital admission

  2. Hospice Consultation

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Frequency of Hospice consultations

  3. Hospice Enrollment

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Frequency of discharge or transition to hospice during or immediately following the hospital stay

  4. Palliative Care Consultation

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Frequency of Palliative Care consultations

  5. Time to change in code status, advance care planning documentation, palliative care consultation, and hospice consultation

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Time in days to the first occurrence of the above outcomes

  6. Inpatient Hospice Duration

    Time frame: From date of enrollment until hospital or hospice discharge, assessed up to 1 year

    Days while patients are enrolled in inpatient hospice (GIP)

  7. Location of discharge disposition

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Discharge disposition to home, skilled nursing facility, long term acute care facility, inpatient rehabilitation, etc.

  8. Hospital Length of Stay

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Length of hospital stay in days

  9. Mortality Index (Vizient)

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Mortality index as calculated by Vizient

  10. Length of Stay Index (Vizient)

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Length of stay index as calculated by Vizient

  11. Operating cost in dollars, including departmental breakdown

    Time frame: Assessed six months following discharge

    Hospital operating cost for each patient, including departmental breakdown such as ICU, pharmacy, procedural, operating room, etc.

  12. Mechanical Ventilation Duration

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Days on mechanical ventilation

  13. Vasopressor Utilization

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Days on vasopressors

  14. Hospital Mortality

    Time frame: From date of enrollment until hospital discharge, assessed up to 1 year

    Inpatient all-cause mortality

  15. 30-Day Mortality

    Time frame: Assessed 30 days after hospital admission

    All-cause mortality within 30 days of hospital admission

  16. 30-day Emergency Room Visit

    Time frame: Assessed 30 days after hospital discharge

    Emergency Room encounter in the same healthcare system within 30 days of discharge

  17. 30-day Readmission

    Time frame: Assessed 30 days after hospital discharge

    Hospital readmission in the same healthcare system within 30 days of discharge

Study contacts

Contact information is provided by the study sponsor or research team.

Stephen Chi, MD

CONTACT

[email protected]

314-273-6176

Sponsors and collaborators

Lead sponsor

Washington University School of Medicine

Other

Registry information

Official study title

Impact of an Embedded Palliative Care and Hospice Practitioner in the Medical ICU

Important dates

Study start
2024
Primary completion
2026
Study completion
2027
First posted
Aug 28, 2024
Registry last updated
Jul 16, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.