Impact of Intensivist Authority on End-of-Life Practices in a Korean PICU

Abstract

Timely end-of-life decision-making is critical for ensuring quality care in the pediatric intensive care unit (PICU). We evaluated the impact of intensivist-led care on the timing and structure of end-of-life (EOL) practices. We retrospectively reviewed 39 PICU deaths over a 3-year period at a tertiary care hospital. Patients were categorized into pre-intensivist (no intensivist), passive-intensivist (intensivist without authority), and active-intensivist (intensivists with full decision-making authority) periods. Physician Orders for Life-Sustaining Treatment (POLST) completion increased (pre: 50.0%, passive: 28.6%, active: 100%; P < .01), while DNR completion declined (pre: 30.0%, passive: 35.7%, active: 0%; P = .049). Time from decision to death increased to 5.0 days (P = .038). Cardiopulmonary resuscitation-related deaths decreased from 30.0% (pre) and 42.9% (passive) to 6.7% (active) and no escalation of support increased to 93.3% during the active-intensivist period (P = .044). Intensivist-led care significantly enhanced POLST documentation and reduced aggressive interventions, promoting structured EOL practices in the PICU.