Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T04:18:59.292Z Has data issue: false hasContentIssue false
  • English
  • Français

Electronic medical orders for life-sustaining treatment in New York State: Length of stay, direct costs in an ICU setting

Published online by Cambridge University Press:  14 January 2019

Denise Serrano-Eanelli ,
Emma Fattakhov ,
Murali Krishna ,
Jill Embler ,
Steven Byrne ,
Claudia DiBlasi ,
Kaitlyn Ludwigsen ,
Yasmin Leigh  and
Hasanat Alamgir
Denise Serrano-Eanelli*
Affiliation:
New York Medical College, Department of Health Policy and Management, Valhalla, NY
Emma Fattakhov
Affiliation:
Orange Regional Medical Center, Middletown, NY
Murali Krishna
Affiliation:
Orange Regional Medical Center, Middletown, NY
Jill Embler
Affiliation:
Orange Regional Medical Center, Middletown, NY
Steven Byrne
Affiliation:
Orange Regional Medical Center, Middletown, NY
Claudia DiBlasi
Affiliation:
Touro College of Osteopathic Medicine, Middletown, NY
Kaitlyn Ludwigsen
Affiliation:
Touro College of Osteopathic Medicine, Middletown, NY
Yasmin Leigh
Affiliation:
Orange Regional Medical Center, Middletown, NY
Hasanat Alamgir
Affiliation:
New York Medical College, Department of Health Policy and Management, Valhalla, NY
*
Author for correspondence: Denise Serrano-Eanelli, 293 Burlingham Rd, Pine Bush, NY 12566. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

In the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, accounting for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals, costing more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a standardized documentation process used in New York State to convey patients’ wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. No study to date has looked at the effect of eMOLST as an advance care planning tool on ICU and hospital costs using estimates of direct costs. The objective of our study was to investigate whether signing of eMOLST results in any reduction in length of stay and direct costs for a community-based hospital in New York State.

Method

A retrospective chart review was conducted between July 2016 and July 2017. Primary outcome measures included length of hospital stay, ICU length of stay, total direct costs, and ICU costs. Inclusion criteria were patients ≥65 years of age and admitted into the ICU with a diagnosis of sepsis. An independent samples t test was used to test for significant differences between those who had or had not completed the eMOLST form.

Result

There were no statistical differences for patients who completed or did not complete the eMOLST form on hospital's total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.

Significance of results

Completing an eMOLST form did not have any effect on reducing total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.

Keywords

Direct costeMOLSTICULOSSepsis
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 5 , October 2019 , pp. 584 - 589
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arefian, H, Heublein, S, Scherag, A, et al. (2017) Hospital-related cost of sepsis: A systematic review. Journal of Infection 74(2), 107–117. doi:10.1016/j.jinf.2016.11.006Google Scholar
Bomba, PA and Orem, K (2015) Lessons learned from New York's community approach to advance care planning and MOLST. Annals of Palliative Medicine 4(1), 10–21. doi:10.3978/j.issn.2224-5820.2015.01.05Google Scholar
Bomba, PA and Orem, K (2017) Response to Clemency et al: Significant errors, gaps in MOLST process, and opportunities for improvement with eMOLST. Journal of the American Medical Directors Association 18(2), 182–184. doi:10.1016/j.jamda.2016.11.005Google Scholar
Bomba, PA and Orem, K (2018) eMOLST: Best practice for improving end-of-life care. Available from https://www.nyshfa.org/files/2018/03/Bomba-eMOLST.NYSFHA.032218.pdfGoogle Scholar
Bond, WF, Kim, M, Franciskovich, CM, et al. (2018) Advance care planning in an accountable care organization is associated with increased advanced directive documentation and decreased costs. Journal of Palliative Medicine 21(4), 489–502. doi:10.1089/jpm.2017.0566Google Scholar
Clemency, B, Cordes, CC, Lindstrom, HA, et al. (2017) Decisions by default: Incomplete and contradictory MOLST in emergency care. Journal of the American Medical Directors Association 18(1), 35–39. doi:10.1016/j.jamda.2016.07.032Google Scholar
Dixon, J, Matosevic, T, and Knapp, M (2015) The economic evidence for advance care planning: Systematic review of evidence. Palliative Medicine 29(10), 869–884. doi:10.1177/0269216315586659Google Scholar
Fitzpatrick, J, Mavissakalian, M, Luciani, T, et al. (2018) Economic impact of early inpatient palliative care intervention in a community hospital setting. Journal of Palliative Medicine 21(7), 933–939. doi:10.1089/jpm.2017.0416Google Scholar
Hickman, SE and Critser, R (2018) National standards and state variation in physician orders for life-sustaining treatment forms. Journal of Palliative Medicine 21(7), 978–986. doi:10.1089/jpm.2017.0606Google Scholar
Huynh, TN, Kleerup, EC, Wiley, JF, et al. (2013) The frequency and cost of treatment perceived to be futile in critical care. JAMA Internal Medicine 173(20), 1887–1894. doi:10.1001/jamainternmed.2013.10261Google Scholar
Khandelwal, N, Benkeser, D, Coe, NB, et al. (2016) Patterns of cost for patients dying in the intensive care unit and implications for cost savings of palliative care interventions. Journal of Palliative Medicine 19(11), 1171–1178. doi:10.1089/jpm.2016.0133Google Scholar
Klingler, C, in der Schmitten, J, and Marckmann, G (2016) Does facilitated advance care planning reduce the costs of care near the end of life? Systematic review and ethical considerations. Palliative Medicine 30(5), 423–433. doi:10.1177/0269216315601346Google Scholar
MacKenzie, MA, Smith-Howell, E, Bomba, PA, et al. (2018) Respecting choices and related models of advance care planning: A systematic review of published evidence. American Journal of Hospice & Palliative Care 35(6), 897–907. doi:10.1177/1049909117745789Google Scholar
Marik, PE (2015) The cost of inappropriate care at the end of life: Implications for an aging population. American Journal of Hospice & Palliative Care 32(7), 703–708. doi:10.1177/1049909114537399Google Scholar
Mendez, CM, Harrington, DW, Christenson, P, et al. (2014) Impact of hospital variables on case mix index as a marker of disease severity. Population Health Management 17(1), 28–34. doi:10.1089/pop.2013.0002Google Scholar
Mun, E, Ceria-Ulep, C, Umbarger, L, et al. (2016) Trend of decreased length of stay in the intensive care unit (ICU) and in the hospital with palliative care integration into the ICU. The Permanente Journal 20(4), 56–61. doi:10.7812/TPP/16-036Google Scholar
Pirozzi, N, Rejali, N, Brennan, M, et al. (2016) Sepsis: Epidemiology, pathophysiology, classification, biomarkers and management. HSOA Journal of Emergency Medicine Trauma and Surgical Care, 3(1).Google Scholar
Rahman, AN, Bressette, M, and Enguidanos, S (2017) Quality of physician orders for life-sustaining treatment forms completed in nursing homes. Journal of Palliative Medicine 20(5), 538–541. doi:10.1089/jpm.2016.0280Google Scholar
Reinhardt, JP, Downes, D, Cimarolli, V, et al. (2017) End-of-life conversations and hospice placement: Association with less aggressive care desired in the nursing home. Journal of Social Work in End of Life and Palliative Care 13(1), 61–81. doi:10.1080/15524256.2017.1282919Google Scholar
Rincon, F and Lee, K (2015) Ethical considerations in consenting critically ill patients for bedside clinical care and research. Journal of Intensive Care Medicine 30(3), 141–150.Google Scholar
Schiefelbein, J, Markovich, Z, and Feingold, A (2014) POLST Registries: Supporting end of life decision making. Policy Research Shop. Dartmouth, The Nelson A. Rockefeller Center for Public Policy and the Social Sciences. Available from https://rockefeller.dartmouth.edu/report/polst-registries.Google Scholar
Smith, TJ and Cassel, JB (2009) Cost and non-clinical outcomes of palliative care. Journal of Pain Symptom Management 38(1), 32–44. doi:10.1016/j.jpainsymman.2009.05.001Google Scholar
Wonnaparhown, A, Shafi, A, Liu, X, et al. (2017) Clinical implications and quality of evidence in metaanalysis about effects of palliative care in critically ill patients in the intensive care unit. Palliative and Supportive Care 15(5), 513–515. doi:10.1017/S1478951516001036Google Scholar