Impact of timing of palliative care team consults in patients with advanced cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18182-e18182
Author(s):  
Thomas Bemis ◽  
Praneeth Baratam ◽  
Dawn Seiders ◽  
Kristine Marie Ward ◽  
Michael Styler

e18182 Background: The 2018 ASCO palliative care guidelines recommend palliative care team (PCT) involvement within 8 weeks for patients with an advanced cancer diagnosis. However, the optimal timing of PCT consults in the inpatient setting has not been established. We investigated whether early PCT involvement for in-patients with an advanced cancer diagnosis affected discharge outcomes. Methods: We queried the Hahnemann University Hospital’s Palliative Care In-patient database between 2015 and 2018 for patients with advanced cancer and an estimated life expectancy of < 6 months. Dates of admission, initial PCT consult and discharge were examined. PCT consults within 7 days of admission were defined as early consults and those > 7 days as late consults. Chi square analysis was used to determine differences in LOS and time from PCT consult to discharge between the two groups. Cost-savings estimates were based on the Kaiser State Health Facts, which list an average cost per inpatient day in US hospitals of $2,289 in nonprofit and $1,791 in for-profit hospitals. Results: The majority of cases (69.7%) had PCT involvement < 7 days from admission and were associated with an overall shorter LOS of 12 days compared to 30 days with consults called > 7 days (p = < 0.001). Furthermore, early PCT involvement led to a 2-day shorter time to discharge (p = < 0.02) for an average cost-savings of at least $4,578 at a non-profit hospital and $3,582 at a for-profit hospital. Conclusions: Our findings show that the majority of patients at our institution with advanced cancer had early PCT involvement, which was associated with reduced hospital length of stay. These findings suggest that PCT involvement may expedite hospital discharge and by extension lead to increased cost-savings and patient quality of life. Future studies will aim to investigate the impact of early PCT involvement on hospital readmission rates and discharge to hospice care among other indicators of improved patient well-being.[Table: see text]

2020 ◽  
Vol 43 (9) ◽  
pp. 405-413
Author(s):  
Arianne Brinkman-Stoppelenburg ◽  
Yvonne Vergouwe ◽  
Monique Booms ◽  
Mathijs P. Hendriks ◽  
Liesbeth A. Peters ◽  
...  

2019 ◽  
Vol 29 (3) ◽  
Author(s):  
Arianne Brinkman‐Stoppelenburg ◽  
Suzanne Polinder ◽  
Branko F. Olij ◽  
Barbara den Berg ◽  
Nicolette Gunnink ◽  
...  

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6638-6638
Author(s):  
Brian Cassel ◽  
Patrick J. Coyne ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Egidio Del Fabbro

6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]


2019 ◽  
Vol 25 (7) ◽  
pp. 345-352
Author(s):  
Federica Sganga ◽  
Christian Barillaro ◽  
Andrea Tamburrano ◽  
Nicola Nicolotti ◽  
Andrea Cambieri ◽  
...  

Aim: To investigate the association between a hospital palliative care unit assessment and hospital outcome. Methods: This was a prospective cohort study. Data were assessed from all patients treated and followed by the hospital palliative care team (HPCT) from November 2016 until December 2017. Results: The mean age of the 588 patients was 73.15±13.6 years. All of the patients included in the study were referred to palliative care. A large proportion of patients were affected by cancer, 69.7% (410), while 30.3% (178) were affected by an advanced chronic illness. The three most frequent cancers were: gastrointestinal (n=81, 19.8%), gynaecological (n=66, 16.1%) and lung (n=63, 15.4%); the three most frequent chronic advanced diseases were: advanced dementia (n=45, 25.3%), severe ischaemic/haemorrhagic stroke (n=36, 20.2%) and severe heart failure (n=25, 15.3%). The majority of patients were in clinical wards (n=476, 81.0%) and the average length of stay was 22.9 days. Hospital outcome trends were evaluated in terms of length of stay and number of deaths that occurred in the hospital. In particular, length of stay decreased from 25.8 days to 18.1 days, hospital death from 13 to 0 during the time that the HPCT assessed patients for an appropriate discharge. Conclusion: The HPCT is an effective means of managing patients affected by severe illness, reducing the number of deaths that occur within the hospital, long periods of hospitalisation and instances of readmission. However, further studies are required to fully assess the impact of an HPCT on hospital outcomes.


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