Enhancing palliative care consultation workflow on an inpatient oncology unit.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 208-208
Author(s):  
Amanda Hazeltine ◽  
Kathryn Liziewski ◽  
Ashley Lin ◽  
Samantha Creamer ◽  
Kathryn Walker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Screening Tool ◽  
Communication Process ◽  
Care Needs ◽  
Multidisciplinary Communication ◽  
Pilot Survey ◽  
Palliative Care Consultation ◽  
Multidisciplinary Rounds ◽  
Care Consultation ◽  
Palliative Care Needs

208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.

scholarly journals 1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

2018 ◽  
Vol 14 (12) ◽  
pp. e775-e785 ◽  
Author(s):  
Anjali V. Desai ◽  
Virginia M. Klimek ◽  
Kimberly Chow ◽  
Andrew S. Epstein ◽  
Camila Bernal ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
Core Values ◽  
Newly Diagnosed ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

scholarly journals Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

2015 ◽  
Vol 22 (7) ◽  
pp. 823-837 ◽  
Author(s):  
Naomi George ◽  
Nina Barrett ◽  
Laura McPeake ◽  
Rebecca Goett ◽  
Kelsey Anderson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Screening Tool ◽  
Content Validation ◽  
Care Needs ◽  
Emergency Department Patients ◽  
Palliative Care Needs

Feasibility Testing of an Emergency Department Screening Tool To Identify Older Adults Appropriate for Palliative Care Consultation

2017 ◽  
Vol 20 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Kei Ouchi ◽  
Susan D. Block ◽  
Mara A. Schonberg ◽  
Emily S. Jamieson ◽  
Emily L. Aaronson ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Palliative Care ◽  
Screening Tool ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Feasibility Testing

Palliative Care for the Interstitial Lung Disease Patient a Must and Not Just a Need

2021 ◽  
pp. 104990912110402
Author(s):  
Said Chaaban ◽  
James McCormick ◽  
Debra Gleason ◽  
Jessica M. McFarlin
Keyword(s):  
Palliative Care ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Disease Patient ◽  
Care Needs ◽  
Life Planning ◽  
Palliative Care Consultation ◽  
End Of Life Planning ◽  
Planning Methods ◽  
Palliative Care Needs

Patients with interstitial lung disease (ILD) have many unmet palliative care needs. The majority of patients with chronic ILD have poor access to a specialist in palliative medicine and that is due to several barriers. The mortality for the ILD patient is high and reaches up to 80% if admitted to the ICU with respiratory failure. Palliative care addresses symptoms in diseases where cure is unlikely or impossible. Palliative care consultation also ensures communication among patients, caregivers and providers regarding treatments, prognosis, and end of life planning. Methods: We performed a literature review on palliative care and ILD, accessing articles published since 2002. We found 71 articles related to the topic. We chose 37 that were most relevant and with no redundancy of information to include in this review. Objectives: Summarize the palliative care needs of patients with ILD, discuss the barriers to receiving palliative care, and summarize clinical practice for providing palliative care to this patient population.

Development and implementation of a palliative care consultation tool

2012 ◽  
Vol 10 (3) ◽  
pp. 171-175 ◽  
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.

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.

Early Identification of Pediatric Neurology Patients With Palliative Care Needs: A Pilot Study

2019 ◽  
Vol 36 (11) ◽  
pp. 959-966
Author(s):  
Ariel Maia Lyons-Warren ◽  
Robert C. Stowe ◽  
Lisa Emrick ◽  
Jill Ann Jarrell
Keyword(s):  
Palliative Care ◽  
Pilot Study ◽  
Hospital Admissions ◽  
Quantitative Measure ◽  
Social Needs ◽  
Care Needs ◽  
Negative Finding ◽  
Pediatric Neurology ◽  
Palliative Care Consultation ◽  
Palliative Care Needs

Palliative care services are beneficial for pediatric neurology patients with chronic, life-limiting illnesses. However, timely referral to palliative care may be impeded due to an inability to identify appropriate patients. The aim of this pilot case–control study was to test a quantitative measure for identifying patients with unmet palliative care needs to facilitate appropriate referrals. First, a random subset of pediatric neurology patients were screened for number of hospital admissions, emergency center visits, and problems on the problem list. Screening results led to the hypothesis that having six or more hospital admissions in one year indicated unmet palliative care needs. Next, hospital admissions in the past year were counted for all patients admitted to the neurology service during a six-month period. Patients with six or more admissions as well as age- and gender-matched controls were assessed for unmet palliative care needs. In hospitalized pediatric neurology patients, having six or more admissions in the preceding year did not predict unmet palliative care needs. While this pilot study did not find a quantitative measure that identifies patients needing a palliative care consultation, the negative finding highlights an important distinction between unmet social needs that interfere with care and unmet palliative care needs. Further, the method of screening patients used in this study was simple to implement and provides a framework for future studies.

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