We read with interest the paper by Digwood et al. in the last issue of Palliative and Supportive Care. The authors report a drop in MICU mortality from 21 to 15.8% (p = 0.003) after the opening of the PCU. The authors explain that at least their findings are due to the ability to transfer ICU patients to the PCU in a seamless manner.
Our group previously published similar results at our cancer center: the number of deaths in MICU dropped from 252/271 (38%) before the inpatient palliative care service to 213/764 (28%) after the opening (p < 0.0001). During this period, the involvement of the palliative care service in the care of patients dying in the hospital grew from 1% to 35%. In our study, very few patients (less than 15%) were actually transferred from MICU to PCU and the overall hospital mortality rate did not increase. Our findings suggest that the presence of a PCU provides a different pathway for symptomatic, decompensated patients that might prevent an MICU admission (Elsayem et al., Reference Elsayem, Smith and Parmley2006). PCUs have been found to provide better care as compared to consultation teams (Casarett et al., Reference Casarett, Johnson and Smith2011), even though patients admitted to PCUs are usually in more severe distress (Bruera & Hui, Reference Bruera and Hui2011). Our findings strongly support those of Digwood et al. Unfortunately, only 23% of United States cancer centers have dedicated palliative care beds (Hui et al., Reference Hui, Elsayem and De la Cruz2010). We hope that as a result of this article and the growing literature, palliative care units will soon become a requirement from a regulatory and ethical perspective in all acute care facilities.
