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

Abstract

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.

The impact of early palliative care interventions on the utilization of medical care resources for end-of-life patients

“…There is evidence to support the cost-effectiveness of palliative care with regards to healthcare costs and the decrease in the utilization of aggressive treatments, including ventilation, endotracheal intubation, and resuscitation [11]. Other studies have indicated that patients who receive palliative care at the end of life will have lower hospitalization rates, fewer ICU days, less active treatment, and a reduced length of hospital stay (LOS) when they receive palliative consultations within 72 hours of being admitted to the hospital [12,13]. Nevertheless, the availability of medical resources can vary depending on the different diseases, clinical practices, and timing of palliative care interventions.…”