The study was published in the American Journal of Hospice & Palliative Medicine and done at Montefiore Medical Center.
“Acute Palliative Care Units, APCUs, are
really a new frontier in managing patients with end-stage chronic
disease,” said study co-author Marlene McHugh, DNP, FNP,
Assistant Professor of Clinical Nursing at Columbia University School of
Nursing and Associate Director of Palliative Care at Montefiore Medical
Center. “In an APCU, patients receive acute and palliative
care regardless of prognosis, the technology required to keep a patient
alive, or end-of-life wishes. In addition, these units are primarily
managed by palliative medicine specialists, working with medical
management.” McHugh is one of the first Nurse Practitioners in New York
City to move palliative care into the acute care hospital setting.
“We are creating the future by bringing
palliative care units within hospital walls,” says co-author Serife Eti,
MD, Director of the Fellowship Program in Palliative Medicine,
Department of Pain Medicine and Palliative Care at Beth Israel Medical
Center. “Consequently, going forward, nurses and medical personnel will
need specialized palliative care training to assist patients with
chronic, advanced and terminal illness in APCUs.”
In the US, the majority of patients with
advanced illness die in acute or long-term care facilities, with around
20% of Americans dying in ICUs. In the absence of specialized units, at
a certain point, patients in an ICU are sent to a general medical unit,
step-down respiratory unit, or must continue care in the ICU.
Establishing APCUs allows patients to leave the ICU yet still receive a
high level of medical care focusing on patients’ values and treatment
preferences, as well as support for their family members.
The study suggests potential cost
benefits can be achieved by managing terminally ill patients in APCUs
rather than in ICUs or MSUs, and that these benefits are more likely to
occur when patients are directly managed by palliative care specialists,
trained in chronic disease management as well as family and end-of-life
counseling. The report notes that this combination of advanced disease
management and personal counseling can assist patients and families in
the transition from aggressive treatment to more palliative care. In
fact, recent studies indicate that palliative care counseling can
shorten ICU stays, reduce costs and enhance the overall quality of care.
Conducted during 2007-2010, researchers
looked at the admissions and economic implications in Intensive Care
Units (ICUs), Medical-Surgical Units (MSUs) and Acute Palliative Care
Units (APCUs), with special focus on Montefiore Medical Center’s APCU in
Bronx, NY.
The study examined several factors at
Montefiore: demographics, diagnosis-related groups, length of hospital
stays, discharge status, and hospital charge data. The research
indicated that a high proportion of patients were admitted to the APCU
from critical care units – indicating there is a pronounced need for
such units to service patients when hospital-based end-of-life care is
needed. It’s noteworthy that the use of ICUs during the last month of
life for Medicare beneficiaries with cancer was dramatically lower
(12.1%) at the Montefiore APCU compared to 137 other academic medical
centers in the US. The creation of the APCU resulted in statistically
significant reductions in both the ICU mortality rate and the length of
stay as terminally ill patients were transitioned out of the ICU.
Hospitals in the U.S. are increasingly
developing units focused on palliative care in order to meet the needs
of advanced and terminally ill patients and their families. This report
recommends hospitals offer full palliative services in order to provide
the best care for terminally ill patients facing complex, long-term
health challenges.