Connecting Anesthesiology, Intensive and Emergency Care with Palliative Care – a novel outcome-based approach for a closer collaboration

• Applicant: Dr. Theresa Tenge
• Subject Area: Anaesthesiology ; Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2023 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 522518834

Palliative care can help to improve the quality of life of patients with life-limiting and life-threatening diseases and their relatives. The integration of palliative care in the fields of intensive care, emergency and perioperative medicine is neither widely implemented in clinical practice nor sufficiently investigated in clinical studies. However, especially in anesthesia, intensive care and emergency medicine, physicians, patients and their relatives are confronted with life-threatening and life-limiting conditions. By integrating palliative care, a number of studies have already demonstrated benefits for patients, caregivers and family members. Not only the conditions at the end of life, which is where many clinicians situate palliative care, could be improved by palliative care integration. The integration of palliative care led to shorter lengths of stay in intensive care units and in the hospital. The proposed project can contribute to a better understanding of the use, need, and benefit of palliative care in the field of anesthesiology. The long-term goal of the project is the development of instruments for optimized and targeted patient care. Using retrospective analyses of the large databases of the Perioperative Outcomes Lab, Center for Anesthesia Research Excellence (CARE) at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School in Boston, we aim to develop an evidence-based and innovative approach for a closer collaboration of palliative care with perioperative anesthesia, intensive care and emergency medicine. In work package 1, the focus lies on preoperative palliative care before elective high-risk interventions with postoperative intensive care stays. The influence of preoperative palliative care on relevant outcome parameters (e.g. intensive care und hospital length of stay, mortality and discharge location) as well as the occurrence of unexpected postoperative intensive care stays will be investigated. In the 2nd work package, we want to develop and validate a predictive score for the detection of palliative need in intensive care patients, similar to already existing risk scores (SOFA, ADELES etc.). In follow-up projects, this score will then be implemented and evaluated at the University Hospital Düsseldorf. With regard to the technical developments in the context of cardiopulmonary resuscitation, such as the use of extracorporeal cardiopulmonary resuscitation with mechanical circulatory assist devices, we would like to address the topic of palliative care integration in resuscitations in the third work package. For all three work packages, the direct clinical transfer of our results to the patient bedside will be the primary focus. Our work should ideally improve the care of patients and their relatives and help to efficiently relieve the burden on clinicians and the resources of the healthcare system.

• DFG Programme: WBP Fellowship
• International Connection: USA
• Host: Privatdozent Dr. Maximilian Schaefer, Ph.D.