Associations between Reason for Inpatient Palliative Care Consultation, Timing, and Cost Savings

Ernecoff, Natalie C.; Bilderback, Andrew; Bellon, Johanna; Arnold, Robert M.; Boninger, Michael L.; Kavalieratos, Dio

doi:10.1089/jpm.2020.0636

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…1 This recommendation was largely based on work that showed earlier placement of do-not-resuscitate orders and withdrawal of life-sustaining medical treatments (LSMTs) through the integration of a structured interdisciplinary PC model in a closed surgical and trauma ICU. 2 Despite the poignancy of these findings and the clear economic and clinical benefit of early specialty PC consultation for noninjured patients, which has been established within the healthcare industry at large, [3][4][5][6] significant barriers to the integration of PC specifically for injured patients as a whole remain. [7][8][9] A 2016 systematic review of the literature on PC interventions in surgical patients demonstrated decreased health care resource utilization and cost when PC principles were used.…”

mentioning

confidence: 99%

Timing is everything: Early versus late palliative care consults in trauma

Spencer

Russell

Cornea

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The incorporation of dedicated palliative care (PC) services in the care of the critically injured trauma patient is not yet universal. Preexisting data demonstrate both economic and clinical value of PC consults, yet patient selection and optimal timing of these consults are poorly defined, possibly leading to underutilization of PC services. Prior studies in geriatric patients have shown benefits of PC when PC clinicians are engaged earlier during hospitalization. We aim to compare hospitalization metrics of early versus late PC consultation in trauma patients. METHODS:All patients 18 years or older admitted to the trauma service between January 1, 2019, and March 31, 2021, who received a PC consult were included. Patients were assigned to EARLY (PC consult ≤3 days after admission) and LATE (PC consult >3 days after admission) cohorts. Demographics, injury and underlying disease characteristics, outcomes, and financial data were compared. Length of stay (LOS) in the EARLY group is compared with LOS-3 in the LATE group. RESULTS:A total of 154 patient records met the inclusion criteria (60 EARLYand 94 LATE). Injury Severity Score, head Abbreviated Injury Scale score, and medical comorbidities (congestive heart failure, dementia, previous stroke, chronic obstructive pulmonary disease, malignancy) were similar between the groups. The LATE group was younger (69.9 vs. 75.3, p = 0.04). Patients in the LATE group had significantly longer LOS (17.5 vs. 7.0 days, p < 0.01) and higher median hospital costs ($53,165 vs. $17,654, p < 0.01).Patients in the EARLY group had reduced ventilator days (2.4 vs. 7.0, p < 0.01) and reduced rates of tracheostomies and surgical feeding tubes (1.7% vs. 11.7%, p = 0.03). CONCLUSION:Trauma patients with early PC consultation had shorter LOS, reduced ventilator days, reduced rates of invasive procedures, and lower costs even after correcting for delay to consult in the late group. These findings suggest the need for mechanisms leading to earlier PC consult in critically injured patients.

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confidence: 99%

Timing is everything: Early versus late palliative care consults in trauma

Spencer

Russell

Cornea

et al. 2022

J Trauma Acute Care Surg

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“…Inpatient palliative care for patients with serious or lifethreatening illnesses has been reported to reduce inpatient length-of-stay, costs, mortality, and prevent readmissions. [1][2][3][4][5][6][7] Not all studies found this to be true. In a systematic review, 12 of 16 studies found that palliative care did not reduce length of stay and only selectively reduced ICU stays in decedents.…”

Section: Introductionmentioning

confidence: 99%

“…6 A third study also found that palliative care consultations within one day of admission reduced length of stay and the cost of care. 5 It is difficult to interpret these studies since there were differences in the structure of palliative care and and varied consult timing.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Palliative Care in Hospital Length of Stay and the Timing of Consultation

Davis

Enkevort

Elder

et al. 2022

Am J Hosp Palliat Care

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Background Inpatient palliative care may reduce length-of-stay, costs, mortality, and prevent readmissions. Timing of consultation may influence outcomes. The aim of this study was to explore the timing of consultation and its influences patient outcomes. Method This retrospective study of hospital consultations between July 1, 2019 and December 31, 2019 compared patients seen within 72 hours of admission with those seen after 72 hours. Outcomes length of stay and mortality. Chi-square analyses for categorical variables and independent t-tests for continuous normally distributed variables were done. For nonparametrically distributed outcome variables, Wilcoxon rank sum test was used. For mortality, a time-to-event analysis was used. 30-day readmissions were assessed using the Fine-Gray sub-distribution hazard model. Multiple regression models were used, controlling for other variables. Results 696 patients were seen, 424 within 72 hours of admission. The average age was 73 and 50.6% were female. Consultation within 72 hours was not associated with a shorter stay for cancer but was for patients with non-cancer illnesses. Inpatient mortality and 30-days mortality were reduced but there was a higher 30-day readmission rate. Discussion Palliative consultations within 72 hours of admission was associated with lower hospital stays and inpatient mortality but increased the risk of readmission. Benefits were largely observed in patients followed in continuity. Conclusion Early inpatient palliative care consultation was associated with reduced hospital mortality, 30-day mortality and length of stay particularly if patients were seen by palliative care prior to hospitalization.

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“…Moreover, palliative care programs have demonstrated the ability to lower the overall cost of care, particularly if provided early in a hospital admission. 1,2 Kupensky et al reported early palliative care consults (<72 h post trauma) for geriatric trauma patients reduced tracheostomy and Percutaneous Endoscopic Gastrostomy (PEG) procedures and hospital stays. 3 An analysis of palliative care 2018 data at Advocate Aurora Health, (over 6000 patients at 9 Illinois hospitals) showed that patients who had a palliative care referral by day 3 of admission had lower overall costs.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Palliative Care Consults Reduce Patients’ Length of Stay and Overall Hospital Costs

Zaborowski¹,

Scheu²,

Glowacki

et al. 2022

Am J Hosp Palliat Care

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Background: Palliative care improves health outcomes and satisfaction and supports decision-making for patients and families during challenging times in their lives. Earlier referral for consults has demonstrated increased costs savings. Hypothesis: Education proposing physicians order a palliative care consult within 3 days of patient hospital admission will decrease patient length of stay (LOS) and overall costs as well as expedite the transition to next level of care. Design/Method: A descriptive retrospective cohort study was completed using de-identified data originally captured for a system-wide initiative at a large acute care hospital in Illinois. Hospitalists were selected as the pilot group and received education encouraging physicians to order palliative care consults within 3 days of patient admission. Non-hospitalists (control group) did not receive the education. All results were compared to a 3-month baseline period. Results: A total of 711 patients were included in this study (367 baseline, 138 pilot, 206 controls). The baseline pre-consult LOS of 4.8 days was reduced to 3.7 days in the pilot group, representing a > 1 day decrease in the timing of palliative consult. The pilot demonstrated a direct cost savings of 26% over the 3-months pilot period. Additionally, a 2-day reduction in overall LOS was demonstrated in the pilot group compared to both the baseline and control groups. Conclusions: This pilot demonstrated an ability to change the timing of new palliative care consults, resulting in direct cost savings and LOS reduction. These results demonstrated the need for a larger study to confirm these findings.

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Associations between Reason for Inpatient Palliative Care Consultation, Timing, and Cost Savings

Cited by 14 publications

References 21 publications

Timing is everything: Early versus late palliative care consults in trauma

Timing is everything: Early versus late palliative care consults in trauma

The Influence of Palliative Care in Hospital Length of Stay and the Timing of Consultation

Early Palliative Care Consults Reduce Patients’ Length of Stay and Overall Hospital Costs

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