Characteristics of Patients in the ICU With Palliative Care Consults in a Tertiary University Hospital

The aim of this retrospective observational single-center cohort study is to investigate the factors associated with palliative care (PC) referral, examine intensive care unit (ICU) involvement before, during, or after the referral, and evaluate patient outcomes such as mortality, hospital and ICU length of stay, discharge destination, functional status, symptom management, and the content of PC consultation reports.

Study Overview

• Status: Active, not recruiting
• Conditions: Palliative Care Referral
• Intervention / Treatment: Other: Palliative care consult

Detailed Description

Palliative care (PC) in the intensive care unit (ICU) can improve care for critically ill patients by supporting decision-making, managing symptoms, and planning for end-of-life care. Early referral to PC has been linked to more do-not-resuscitate and do-not-intubate decisions, fewer ICU procedures, and more transfers to hospice care. However, PC is still underused in many ICUs, partly because doctors often overestimate patient survival. Most referral guidelines are based on older patients or those with serious conditions, which may not apply to younger or potentially recovering patients.

Existing studies mostly focus on survival or length of stay, with limited information on symptoms, functional recovery, or patient comfort. Some research suggests that PC needs are often not well met in the ICU.

This retrospective single-center cohort study aims to better understand when and why ICU patients are referred to PC, how their care changes, and what outcomes follow. It will also examine symptom management, functional outcomes, and recommendations made by the PC team.

The results of this study may help improve the timing and use of PC in the ICU to better support patient needs.

• Study Type: Observational
• Enrollment (Actual): 532

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland, 4031
    • University Hospital Basel, Clinic for Intensive Care Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

All consecutive adult patients (i.e. >= 18 years of age) that received a palliative care consult in the same hospitalization as their ICU stay at the University Hospital Basel between 2019 and until the end of 2024. .

Description

Inclusion Criteria:

• Adult patients (i.e., patients ≥18 years of age)
• Palliative care consult either before, during or after a ICU stay at the University Hospital Basel between 2019 and until the end of 2024

Exclusion Criteria:

• Patients younger than 18 years
• Patients with documented refusal to use data

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Before ICU stay; Adult patients with a PC consult before an ICU stay at the University Hospital Basel between 2019 and until the end of 2024.	Other: Palliative care consult; A palliative care (PC) consult involves a specialized palliative care team to provide symptom management, psychosocial support, and assistance with goals-of-care discussions for patients with serious or life-limiting illnesses.
During ICU stay; Adult patients with a PC consult during an ICU stay at the University Hospital Basel between 2019 and until the end of 2024.	Other: Palliative care consult; A palliative care (PC) consult involves a specialized palliative care team to provide symptom management, psychosocial support, and assistance with goals-of-care discussions for patients with serious or life-limiting illnesses.
After ICU stay; Adult patients with a PC consult after an ICU stay at the University Hospital Basel between 2019 and until the end of 2024.	Other: Palliative care consult; A palliative care (PC) consult involves a specialized palliative care team to provide symptom management, psychosocial support, and assistance with goals-of-care discussions for patients with serious or life-limiting illnesses.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient demographics	Demographic information (e.g. age, sex) is collected.	2019-2024
Acute prehospital management data	Data from acute prehospital management, as documented in emergency medical services (EMS) treatment protocols, is collected. The collected data elements are aggregated to describe the overall EMS response.	2019-2024
Duration of intensive care unit stay	The length of intensive care unit (ICU) stay is recorded.	2019-2024
Duration of hospital stay	The length of the total hospital stay is recorded.	2019-2024
Discharge destination	The destination at discharge is recorded.	2019-2024
Date of palliative care consult	The specific date of palliative care consult is documented.	2019-2024
Reason for palliative care consult	The documented reason for palliative care consult is analyzed.	2019-2024
Place of palliative care consult	The specific place of palliative care consult is documented.	2019-2024
Number of visits by the palliative care team	The number of visits by the palliative care team is analyzed.	2019-2024
Additional features of the palliative care consult	Assessment of additional features related to the palliative care consult (changes in management, referral for psychiatric or psychological evaluation, treatment recommendations, etc.) documented in the medical records or consult report. These features are aggregated to characterize the scope, complexity, and potential impact of the palliative care consultation on the patient's overall treatment and care trajectory.	2019-2024
Comprehensive assessment of the neurological status based on validated clinical assessment	Neurological status during ICU stay is assessed using available data in the patient register from validated neurological assessments. These may include the Richmond Agitation-Sedation Scale (RASS), Sedation-Agitation Scale (SAS), Glasgow Coma Scale (GCS), Intensive Care Delirium Screening Checklist (ICDSC), or Status Epilepticus Severity Score (STESS). The specific tool used, as well as the scale of the score and meaning behind the score, depends on routine clinical practice and available documentation in the register. If multiple scores are available for a patient, they will be aggregated to provide a comprehensive assessment of neurological status. This outcome will be reported as a descriptive summary, synthesizing findings across tools, rather than as a single quantitative score.	2019-2024
Comprehensive assessment of critical illness severity based on standardized scoring systems	Disease severity during ICU stay is assessed using standardized scoring systems, including the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA), depending on data availability in the patient register. The specific scoring system applied, as well as the scale and interpretation of the score, varies based on routine clinical practice and available documentation. Where multiple severity scores are available, they will be synthesized to provide a descriptive summary of overall illness severity rather than a single quantitative score.	2019-2024
Charlson Comorbidity Index	The Charlson Comorbidity Index (CCI) is calculated based on pre-existing comorbidities and additional diagnoses. The CCI predicts the ten-year mortality for a patient who may have a range of comorbid conditions. It assigns weighted scores (from 0 to maximal 6) to 17 comorbid conditions (e.g., heart disease, diabetes, cancer), resulting in a total score ranging from 0 to 33, if the patient had the most severe form of each of the 17 conditions.	2019-2024
Laboratory parameters	Routine laboratory value for e.g. C-Reactive Protein (CRP), albumin, Lactate Dehydrogenase (LDH), Creatine Kinase (CK), procalcitonin, white blood cell levels, creatinine, liver enzymes, blood gas analyses, metabolic data, etc. is collected. The specific parameters recorded may vary depending on the laboratory assessments documented in the patient register. All values will be reported using their respective units of measurement.These parameters are aggregated to support an overall clinical interpretation rather than a single numerical value. This approach reflects standard clinical practice, where multiple lab values are considered together to assess a patient's condition.	2019-2024
Complications associated with palliative Care consult	The complications occurring during or after the palliative care consultation are recorded, including inadequate symptom control, dissatisfaction expressed by the patient or relatives, cardiac arrest, unplanned emergency transfers to the ICU, and poor functional outcomes.	2019-2024
Glasgow Outcome Score	The Glasgow Outcome Score (GOS) is calculated based on the assessment of key clinical outcomes such as inhospital mortality, survival, survival with neurofunctional alteration, return to premorbid neurological function, and hospital readmission to determine the patient outcome. The GOS ranges from 1 (death) to 5 (good recovery).	2019-2024
Therapeutic intervention	The therapeutic intervention is documented, including information on duration, dosage and number of treatment medication, number of neuroleptic, sedative and analgesic drugs, invasive procedures, such as intubation, mechanical, ventilation, vasopressors, installation of central lines, nutrition, etc.	2019-2024
Vital signs	Vital signs are analyzed based on the data available in the patient register. These may include blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, level of consciousness, etc. The specific parameters recorded depend on the clinical documentation available. All values will be reported using their respective units of measurement. These values are aggregated to support an overall clinical assessment rather than a single numerical score. This reflects standard practice, where multiple vital signs are interpreted together to evaluate a patient's condition.	2019-2024
Fluid balance data	Fluid balance data, including the administration of fluids such as blood products, crystalloids, and enteral/parenteral nutrition, are documented. These components are aggregated to represent overall fluid input for each patient.	2019-2024
Assessment of diagnostic procedure	The diagnostic procedures performed during intensive care-whether invasive (e.g., lumbar puncture, central line placement) or non-invasive (e.g., radiologic imaging, ultrasound)-are systematically documented. Additionally, if physical restraints are used to ensure patient safety or procedural success, their usage are also recorded.	2019-2024

Collaborators and Investigators

• Sponsor: University Hospital, Basel, Switzerland
• Investigators: Principal Investigator: Raoul Sutter, Prof. Dr. med., University Hospital Basel, Clinic for Intensive Care Medicine

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2025
• Primary Completion (Estimated): December 1, 2029
• Study Completion (Estimated): December 1, 2029

Study Registration Dates

• First Submitted: May 8, 2025
• First Submitted That Met QC Criteria: May 21, 2025
• First Posted (Actual): May 22, 2025

Study Record Updates

• Last Update Posted (Actual): June 17, 2026
• Last Update Submitted That Met QC Criteria: June 15, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Intensive Care Unit
• Other Study ID Numbers: 2025-00734; am25Sutter4

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No