Determining Palliative Care Penetration Rates in the Acute Care Setting

Gruhler, Heidi; Krutka, April; Luetke-Stahlman, Hannah; Gardner, E

doi:10.1016/j.jpainsymman.2017.09.013

Cited by 7 publications

(11 citation statements)

References 12 publications

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“…Thus, innovative and systematic strategies are needed to augment clinician referral of patients most likely to benefit from earlier palliative care consultation. [10][11][12] There has been a growing interest in triggering palliative care consultation using several different criteria, such as selected diagnoses, 13,14 disease-specific prognostic indicators, 15,16 or a patient's location. [17][18][19] Although sound in principle, these approaches are nonspecific and assume palliative care needs and are therefore unlikely to be scalable given the growing number of seriously ill patients and the limited palliative care specialist workforce in the USA.…”

Section: Introductionmentioning

confidence: 99%

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study

et al. 2019

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Section: Introductionmentioning

confidence: 99%

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study

et al. 2019

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“…Regarding the decrease in PC consultation rate at 6 months postintervention, we hypothesize that as residents felt more confident in undertaking SICs, they felt less in need of PC specialist support. As prior research has demonstrated that up to 26% of acute care patients have PC needs ( 18 , 19 ), an intervention such as ours could greatly ease the burden on a limited resource such as PC consulting physicians. However, we must be mindful of the possibility that interventions such as ours could instill a false confidence in our residents and that reduced PC consultation could also reflect patients not receiving services that could improve their care quality.…”

Section: Discussionmentioning

confidence: 99%

Effect of Palliative Care Curriculum on Serious Illness Conversation Preparedness

et al. 2021

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Background A shortage of palliative pare (PC) specialists underscores the necessity that all clinicians feel comfortable with serious illness conversations (SICs). Objective To assess the effect of an intensive PC curriculum with multiple teaching modalities on Internal Medicine residents’ confidence with SICs and advance care planning documentation. Methods Twelve PC modules consisting of didactic lectures, role-playing, and online interactive modules were integrated as continuing education during academic year 2018–2019. Surveys were administered precurriculum and at 3 and 6 months postcurriculum to measure the primary outcome of increasing resident preparedness for SICs. A retrospective chart review was used to analyze secondary outcomes of advance care planning documentation for patients cared for by residents exposed to the curriculum versus residents from the previous year who received monthly didactic PC lectures. Results Postintervention surveys demonstrated statistically significant improvement in resident confidence. An increase in patient code status confirmation rates (odds ratio, 1.81; 95% confidence interval, 1.12–2.94; P = 0.02) and a decrease in PC consultation (odds ratio, 0.56; 95% confidence interval, 0.33–0.97; P = 0.04) was observed when compared with the previous year. Conclusion Among residents, the incorporation of an intensive PC curriculum that uses multiple teaching modalities improves confidence in SICs, which we believe is integral to the practice of goal-concordant patient care.

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“…29 Given the severity of disease and poor prognosis in this patient cohort, we expected a higher consultation rate. [33][34][35][36][37][38] It is possible that providers did not consider involvement of palliative care until all life-prolonging measures had been attempted or exhausted. This is supported by the low rates of documented GoC discussions, leaving little time to involve palliative care providers prior to a patient's death.…”

Section: Discussionmentioning

confidence: 99%

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Brooten

Buckenheimer

Hallmark

et al. 2020

WestJEM

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Introduction: Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. Methods: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. Results: We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. Conclusion: The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area. [West J Emerg Med. 2020;21(4)935-942.]

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Determining Palliative Care Penetration Rates in the Acute Care Setting

Abstract: This study successfully optimized an electronic palliative care identification algorithm with a PPV of 80.1% and indicates appropriate palliative care penetration rates may be as high as 26.4% of the total inpatient population.

Cited by 7 publications

References 12 publications

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study

Effect of Palliative Care Curriculum on Serious Illness Conversation Preparedness

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

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