Impact of early palliative care consultation on inpatient length of stay and discharge disposition among oncology patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 53-53
Author(s):  
Ajay Dhakal ◽  
Suvash Shrestha ◽  
Peter Homel ◽  
Beth Popp
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Living Condition ◽  
Advanced Illness ◽  
Early Palliative Care ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
To Receive

53 Background: As palliative care develops as a medical subspecialty, studies are needed to assess its impact on patient care. Studies examining the effect of inpatient palliative care consult (PCC) on the admission length of stay (LOS) for non-ICU patients have failed to demonstrate consistent results. Also, there is a paucity of data on the effect of PCC on discharge disposition. The objective of this study is to examine the effect of early PCC on the length of stay and discharge disposition among cancer patients discharged alive. Methods: A retrospective review of oncology inpatients (pts) from January 2011 to Jan 2014 of whom 307 had PCC (PC group) and 305 pts did not have PCC (NC group). Visits less than 4 days, those ending with in-hospital deaths and those with PCC called more than 3 days into the admission were excluded. Groups were randomly matched based on All Patient Refined Diagnosis Related Group (APR DRG) Severity of Illness scores. Median LOS was compared with the Mann Whitney test. Pts coming from home without services (certified home health agency, advanced illness management, hospice, skilled nursing facility, or rehabilitation center) and discharged with services were considered favorable dispositions; any discharge without services was considered unfavorable disposition; all other dispositions considered neutral. Chi Square test was used to analyze discharge disposition. Results: The demographic profiles of 2 groups were similar in age, race, religion, marital status, insurance and living condition; females were more likely to get PCC (60 % vs 44 %, p<0.001). Median (minimum, maximum) LOS for PC group was longer by 1 day: 8 (4, 76) days vs 7 (4, 251) days for NC group (p=0.003). PC group was more likely to receive a favorable discharge disposition (45 % vs 36 %); less likely to receive unfavorable discharge (13 % vs 28 %, overall p < 0.001). Neutral dispositions were similar (41% vs 35 %). Conclusions: Oncology pts with PCC have 1 day longer LOS compared to those without it but are more likely to get a favorable discharge disposition. This may favorably impact readmission rates, which we hope to study in the future.

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?

2017 ◽  
Vol 31 (4) ◽  
pp. 378-386 ◽  
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.

Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. 23-29
Author(s):  
Kim Martz ◽  
Jenny Alderden ◽  
Rick Bassett ◽  
Dawn Swick
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Screening Tool ◽  
Care Delivery ◽  
Screening Tools ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
To Receive

Background Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. Objective To identify outcomes associated with specialty palliative care referral among patients with critical illness. Methods Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. Results Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P &lt; .001). Conclusions Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

scholarly journals Early Palliative Care Intervention Helps with Decreased Length Of Stay And Cost Cutting In A Safety Net Hospital In The Central Valley Of California.

2020 ◽  
Author(s):  
Soujanya Sodavarapu ◽  
Siamak M Seraj ◽  
Gurinder Ghotra ◽  
Malkinder Singh ◽  
Nasim Khosravi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Safety Net ◽  
Cost Of Care ◽  
Public Hospitals ◽  
Early Palliative Care ◽  
Care Intervention ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Total Charges

Objective: To determine if early palliative care intervention within two days of hospital admission affects the length of stay and cost savings. Methods: Using a retrospective chart review, 570 patients who received palliative care consultation were reviewed between 2016 and 2018. 287 patients were seen within 2 days of days and the total 355 were seen within 3 days of admission. Data on length of stay and total charges were analyzed for both groups. Results: In the early consult group, both lengths of stay and cost of care in total charges decreased by 64% (p<0.0001) and 58% (p<0.0001), respectively. Multiple linear regressions showed everyone day increase in the date of the consultation is associated with an increase in the length of stay by 1.02 days. (R-squared 0.65, p-value <0.0001, CI 0.95-1.09). The number of palliative care consultations increased by 60% from 2016 to 2017. Conclusion: Our study reiterates the importance of a multidisciplinary approach in identifying patients who will benefit from palliative care consultation and addressing goals of care early in their hospital course. As such, our study suggests the importance of emphasizing early palliative care and its potential benefits in public hospitals.

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

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 (&lt;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 &gt;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.

scholarly journals Hospital-Wide Impact of Early Palliative Care Interventions on Direct Costs and Length of Stay (S734)

2018 ◽  
Vol 55 (2) ◽  
pp. 674-675 ◽  
Author(s):  
Masaya Higuchi ◽  
Jorge Luna ◽  
Craig Blinderman ◽  
Hojjat Salmasian ◽  
David Vawdrey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Direct Costs ◽  
Early Palliative Care
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