Implementing an emergency department EMR trigger tool for palliative medicine consultation and its effect on length of stay and health care costs: A retrospective study.
167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. Methods: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR. Patients who met criteria for a palliative consultation as determined by ED physicians at the time of inpatient admission were tracked by the palliative medicine department as part of a pilot phase. Those that were triggered and received usual care made up the control group. The intervention group was made up of patients who were triggered and seen in consultation. Results: Patients who were seen within 3 days of trigger were found to have a mean length of stay of 7.57 days, while those seen after 3 days had a mean length of stay 10.61 days. Patients who were triggered for metastatic cancer were found to have differences in final disposition between the two groups. Discharge to subacute rehabilitation facilities (SAR) in these patients decreased from 24% in the control group to 12% in the intervention group, while use of home hospice more than doubled to 11%. The percentage of these patients dying in the hospital decreased from 18% to 12%. Conclusions: Our study showed that earlier consultation was associated with shorter hospital length of stays if patients were seen within 3 days of being flagged as having palliative care needs in the ED. We also found that our EHR trigger doubled home hospice utilization in patients with metastatic cancer, decreased the proportion of discharges to SAR, and decreased in-hospital death in these patients.