Early palliative care consultation reduces hospital costs

Inpatient palliative care consultation has been demonstrated to improve quality of life as well as decrease hospital readmissions, intensive care unit transfers, and hospital costs for people with a life limiting illness. The clinical teaching units (CTUs) at London Health Sciences Centre (LHSC) routinely admit patients with noncurable cancer as well as end-stage heart, lung, liver, or kidney disease. However, the use of inpatient palliative care consultations for CTU patients remains unexamined. We conducted a descriptive study of all patients referred from LHSC CTU from both University and Victoria hospital to inpatient palliative care over a 1-year period from August 2013 to July 2014. The purpose of this study was to characterize the population and identify possible areas for quality improvement. In a 1-year period, 638 patients were referred from CTU to the inpatient palliative care consultation service. Of referrals, 55% died during their admission. Based on data collected, we conclude that many patients are referred early in their admission to CTU and patients are referred for a variety of noncancer diseases, suggesting knowledge and appreciation of the benefit of early palliative care consultation for malignant and nonmalignant disease. However, when further analyzed, there is indication that patients with noncancer diagnoses are referred statistically significantly later than those with a cancer diagnosis. The CTUs are sites of core medical training, and therefore, it is imperative that we model early integration of palliative care in order to continue to improve care of patients at end of life.

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Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

Journal of Burn Care & Research ◽

10.1093/jbcr/irab140 ◽

2021 ◽

Author(s):

Heather Carmichael ◽

Hareklia Brackett ◽

Maurice C Scott ◽

Margaret M Dines ◽

Sarah E Mather ◽

...

Keyword(s):

Palliative Care ◽

Small Sample ◽

Quality Improvement Initiative ◽

Comfort Care ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Before And After ◽

Care Consultation ◽

Patient Values ◽

The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

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The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.131 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 131-131

Author(s):

Kazuhiro Kosugi ◽

Fumio Omata ◽

Yoshiyuki Fujita ◽

Akitoshi Hayashi

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

Rank Test ◽

Unresectable Pancreatic Cancer ◽

Poor Prognostic Factor ◽

Early Palliative Care ◽

Ajcc Stage ◽

Palliative Care Consultation ◽

Care Consultation ◽

Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

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In high-risk ICU patients, early palliative care consultation increased transition to DNR/DNI status

Annals of Internal Medicine ◽

10.7326/acpj202003170-030 ◽

2020 ◽

Vol 172 (6) ◽

pp. JC30

Author(s):

Saraschandra Vallabhajosyula ◽

Cory Ingram

Keyword(s):

Palliative Care ◽

High Risk ◽

Icu Patients ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Health Affairs ◽

10.1377/hlthaff.2010.0929 ◽

2011 ◽

Vol 30 (3) ◽

pp. 454-463 ◽

Cited By ~ 283

Author(s):

R. Sean Morrison ◽

Jessica Dietrich ◽

Susan Ladwig ◽

Timothy Quill ◽

Joseph Sacco ◽

...

Keyword(s):

Palliative Care ◽

Hospital Costs ◽

Palliative Care Consultation ◽

Care Consultation ◽

Medicaid Beneficiaries

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Development and implementation of a palliative care consultation tool

Palliative & Supportive Care ◽

10.1017/s1478951511000848 ◽

2012 ◽

Vol 10 (3) ◽

pp. 171-175 ◽

Cited By ~ 12

Author(s):

Alexei Trout ◽

Kenneth L. Kirsh ◽

John F. Peppin

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Screening Tool ◽

Average Length ◽

Hospital Costs ◽

Initial Attempt ◽

Palliative Care Consultation ◽

Time Period ◽

Care Consultation ◽

Chi Square Analysis

AbstractObjective:Palliative care services are becoming more commonplace in hospitals and have the potential to reduce hospital costs through length of stay reduction and remediation of symptoms. However, there has been little systematic attempt to identify when a palliative care consultation should be triggered in a hospital, and there is some evidence that these services are under-utilized and not fully understood.Method:In an initial attempt to address when a consultation might be appropriate, we attempted to pilot test a novel palliative care screening tool to help guide clinician judgment in this regard. A one-page, face-valid instrument was developed using expert opinion.Results:The sample comprised 33 men (44.6%) and 41 women (55.4%) with an average age of 63.4 years (SD = 13.8) and an average length of stay of 22.7 days (SD = 10.1). The most significant symptom was pain, indicated as moderate-to-severe in 23 patients (31%). This was followed by fatigue (n = 10, 13.5%) and nausea (n = 6, 8.1%). At unit entry, 20 patients (33%) had moderate or severe pain. Upon discharge, this number had been reduced to 12/60 (20%). Chi-Square analysis showed a significant decrease in pain rankings overall (χ2 = 36.3, p < 0.0001). The average total tool score was 7.5 (SD = 3.1). Using an initial threshold of 12 to trigger a palliative care referral, 64 patients (86.5%) would not have received a referral and 10 (13.5%) would have. Of these 10 patients, 2 (20%) did not receive a palliative care consultation while they were hospitalized.Significance of results:The tool we developed increased consultations over the time period in which it was used, compared with the same time period 1 year prior. Although the threshold developed for triggering referrals seemed artificially high, the implementation of the screening tool did increase referrals.

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Early Palliative Care Consultation in the Medical ICU

Critical Care Medicine ◽

10.1097/ccm.0000000000004016 ◽

2019 ◽

Vol 47 (12) ◽

pp. 1707-1715 ◽

Cited By ~ 13

Author(s):

Jessica Ma ◽

Stephen Chi ◽

Benjamin Buettner ◽

Katherine Pollard ◽

Monica Muir ◽

...

Keyword(s):

Palliative Care ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

Palliative Medicine ◽

10.1177/0269216317690098 ◽

2017 ◽

Vol 31 (4) ◽

pp. 378-386 ◽

Cited By ~ 44

Author(s):

Peter May ◽

Melissa M Garrido ◽

J Brian Cassel ◽

Amy S Kelley ◽

Diane E Meier ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Length Of Stay ◽

Advanced Cancer ◽

Intervention Group ◽

Cost Savings ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

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