An interventional study of Embedded Hospice and Palliative Care Practitioner and Embedded Hospice and Palliative Care Practitioner (Group Effect) in Critical Illness, End of Life and Quality of Life, sponsored by Washington University School of Medicine. Recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-07-16.
Sponsored by Washington University School of Medicine · Not applicable, Interventional, and Supportive care
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.
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.
456 studies on the registry are indexed under Death; 86 are open to participants now.
This study's planned enrollment of 2,600 is above the median of 163 across 210 interventional studies indexed under Death.
Browse Death studies →Washington University School of Medicine is the lead sponsor of 1,803 studies on the registry; 271 are open to participants now.
Of its 329 completed or terminated interventional studies of FDA-regulated products, 216 (66%) have results posted.
Compared within Death, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Critical Illness. The counts are of registry records indexed under each term, refreshed daily. How we classify →
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
This arm comprises patients admitted to the specific medical intensive care unit in which the hospice and palliative care practitioner is currently active. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, followed by all patients admitted to both medical intensive care units during the second half of the intervention timeframe.
Other: Embedded Hospice and Palliative Care Practitioner
This arm comprises patients admitted to the medical intensive care unit in which the hospice and palliative care practitioner is not currently active, but which may experience a group effect due to the study's ongoing enrollment and the practitioner's presence. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, prior to the practitioner becoming active in both intensive care units.
Other: Embedded Hospice and Palliative Care Practitioner (Group Effect)
This arm comprises historical patients admitted to the medical intensive care units in the year prior to study enrollment.
Other: None (Historical)
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.
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.
This control arm includes historical patients admitted to the medical intensive care units prior to the study's enrollment timeframe.
ICU Length of Stay
Length of stay in any intensive care unit during the hospitalization
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Code Status De-escalation
Frequency of changes in code status to limited code or comfort measures only
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Presence of Advance Care Planning Documentation during Current Admission
Documentation of advance directives, limitations in life-sustaining treatments, or code status that is newly created during the active hospital admission
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Hospice Consultation
Frequency of Hospice consultations
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Hospice Enrollment
Frequency of discharge or transition to hospice during or immediately following the hospital stay
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Palliative Care Consultation
Frequency of Palliative Care consultations
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Time to change in code status, advance care planning documentation, palliative care consultation, and hospice consultation
Time in days to the first occurrence of the above outcomes
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Inpatient Hospice Duration
Days while patients are enrolled in inpatient hospice (GIP)
Time frame: From date of enrollment until hospital or hospice discharge, assessed up to 1 year
Location of discharge disposition
Discharge disposition to home, skilled nursing facility, long term acute care facility, inpatient rehabilitation, etc.
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Hospital Length of Stay
Length of hospital stay in days
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Mortality Index (Vizient)
Mortality index as calculated by Vizient
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Length of Stay Index (Vizient)
Length of stay index as calculated by Vizient
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Operating cost in dollars, including departmental breakdown
Hospital operating cost for each patient, including departmental breakdown such as ICU, pharmacy, procedural, operating room, etc.
Time frame: Assessed six months following discharge
Mechanical Ventilation Duration
Days on mechanical ventilation
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Vasopressor Utilization
Days on vasopressors
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
Hospital Mortality
Inpatient all-cause mortality
Time frame: From date of enrollment until hospital discharge, assessed up to 1 year
30-Day Mortality
All-cause mortality within 30 days of hospital admission
Time frame: Assessed 30 days after hospital admission
30-day Emergency Room Visit
Emergency Room encounter in the same healthcare system within 30 days of discharge
Time frame: Assessed 30 days after hospital discharge
30-day Readmission
Hospital readmission in the same healthcare system within 30 days of discharge
Time frame: Assessed 30 days after hospital discharge
PDFs hosted by the registry, ClinicalTrials.gov.
Plan to share: No
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