The Use of a Palliative Care Screening Tool to Improve Referrals to Palliative Care Services in Community-Based Hospitals

Abstract

Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do-Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017. The intervention was implemented in 3 different units, each within community hospitals. Patients 18 years or older were screened if they were admitted to one of the selected units for the project, regardless of their diagnosis, age, or comorbidities. The percentage of newly admitted patients who were screened and the total number of palliative care consults were assessed as outcome measures. The tool was met with varying compliance among the 3 sites. However, there was an overall increase in consults across all hospital sites, and an increase in the proportion of noncancer patients was demonstrated. Although the aim was not reached, the tool helped to create a shift in the demographic of patients identified as palliative.

Timely Palliative Care: Personalizing the Process of Referral

“…To date, only a handful of studies have examined systematic screening to trigger palliative care referral. Although triggered referral can also apply to inpatient palliative care [ 73 , 74 , 75 , 76 , 77 , 78 ], the focus of our discussion is on outpatient palliative care given it is the ideal setting for timely referral.…”

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

“…A workgroup developed the screening tool criteria based on a literature review of evidence-based tools and best practices 2,3,6-11,13-17,19 . This group also determined the automated alert and implementation process.…”

“…1,2,6,7 Regardless of the evidence surrounding the benefits of early referrals, hospitalized patients are often referred very late or not referred at all, and thereby do not receive the benefits of palliative care. 8,9 Previous studies reveal that clinicians are often inaccurate in determining prognosis, and as a result, palliative care is often implemented late. 7,10,11 Barriers to achieving early referrals include a lack of both education about palliative care benefits and processes to assist with identifying patients who may benefit from palliative care services.…”

“…Regardless of the evidence surrounding the benefits of early referrals, hospitalized patients are often referred very late or not referred at all, and thereby do not receive the benefits of palliative care 8,9 . Previous studies reveal that clinicians are often inaccurate in determining prognosis, and as a result, palliative care is often implemented late 7,10,11 .…”

“…Previous initiatives focusing on the implementation of screening tool processes using Plan-Do-Study-Act (PDSA) cycles and logic model methodology reported increases in appropriate referrals to palliative care from 9% to 36% 3,8 . Two studies examined the implementation of palliative screening processes in medical intensive care units (MICUs) and their sample sizes varied from 223 to 610 observations 16,17 .…”