METHODS: This was a retrospective cohort of all patients with an ID consult within an academic health system 1/1/2014 - 12/31/2023, including community, general, and transplant ID consult services.
RESULTS: There were 60,820 inpatient ID consults (17,235 community, 29,999 general, and 13,586 transplant) involving 37,848 unique patients. The number of consults increased by 94% and the rate rose from 5.0 to 9.9 consults per 100 inpatients (p<0.001). In total, 7.5% of patients receiving an ID consult died during admission, and 1,006 (2.6%) of patients were discharged to hospice. In-hospital mortality was 5.2% for community ID, 7.8% for general ID, and 10.7% for transplant ID patients (p<0.001). Six-month mortality was 9% for all non-obstetric admissions, , vs. 19% for community ID, 20.9% for general ID, and 22.3% for transplant ID.In total 2,866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization. The index ID consult preceded any palliative consult in the majority (69.5%) of cases. 16.3% of patients had a do-not-resuscitate order during the index hospitalization. 12.2% of all patients with a do-not-resuscitate order had this placed on the same day as the ID consult.
CONCLUSIONS: Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care.
方法:这是一个回顾性队列研究,包括2014年1月1日至2023年12月31日在学术卫生系统内进行ID咨询的所有患者,包括社区,一般,和移植ID咨询服务。
结果:有60,820名住院患者ID咨询(17,235个社区,29,999一般,和13,586例移植),涉及37,848例独特患者。咨询次数增加了94%,比率从每100名住院患者5.0次上升到9.9次(p<0.001)。总的来说,接受身份咨询的患者中有7.5%在入院期间死亡,另有1,006名(2.6%)的病人出院到临终关怀医院。社区ID的住院死亡率为5.2%,普通身份证7.8%,移植ID患者为10.7%(p<0.001)。所有非产科入院的六个月死亡率为9%,,vs.19%为社区ID,一般身份证20.9%,移植ID为22.3%。在同一住院期间,总共有2,866名(7.6%)接受ID咨询的患者也接受了姑息治疗咨询。在大多数情况下(69.5%),索引ID咨询先于任何姑息性咨询。16.3%的患者在住院期间有不复苏的顺序。在所有接受不复苏命令的患者中,有12.2%在ID咨询的同一天放置了此命令。
结论:接受身份咨询的患者越来越复杂,更有可能在咨询后很快死亡。这些结果为ID临床医生提供了一个框架,以考虑他们在临终关怀中的作用。