Development and Implementation of a Real-Time Inpatient Palliative Care Screening Process to Promote Earlier Palliative Care Referrals

Abstract

Despite the previous development of criteria for palliative screening tools, there remains a lack of validated and practical screening processes for the general hospitalized patient population for everyday clinical use. This quality improvement project's aim was to implement a practical institution-based adult inpatient palliative care screening tool embedded into the electronic medical record with an automated alert process to assist in identifying patients earlier within hospital admission. The project used a preimplementation and postimplementation design and followed the Plan-Do-Study-Act process to measure the effectiveness of the tool and alert process in decreasing time from admission to palliative care referral and impact on referring patterns. During the project period, 1851 palliative care referrals were completed, and minimal difference (0.6%) was noted in the average time from admission to referral preimplementation and postimplementation (P = .939). There was a 3.7% increase in referrals postimplementation and a shift in referring service patterns (P = .321). Although the expected outcome of earlier palliative referrals during admissions was not met, the development and implementation of the tool and alert process is a step toward the creation of a standard practical tool for the general hospitalized patient population.

Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU)

“…11 Increased consultations and workload were reported in other studies where patients were screened for palliative care needs by implementing triggers and other consult systems. 10,17 The increased workload fostered by a higher numbers of consultations may have an effect on staffing levels of palliative care experts.…”