%0 Journal Article
%T Beyond Infection: Mortality and End-of-Life Care Associated with Infectious Disease Consultation in an Academic Health System.
%A Smith AGC
%A Yarrington ME
%A Baker AW
%A Cox GM
%A Dicks KV
%A Engemann JJ
%A Kohler P
%A Mourad A
%A Raslan R
%A Santivasi WL
%A Turner NA
%A Wrenn RH
%A Zavala S
%A Stout JE
%J Clin Infect Dis
%V 0
%N 0
%D 2024 Jun 13
%M 38867715
%F 20.999
%R 10.1093/cid/ciae325
%X <B>BACKGROUND: </B>Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.