Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality

Abstract

Background: Inpatient palliative care consultation (PCC) may reduce 30-day readmissions and inpatient mortality among seriously ill patients. Objective: To evaluate the impact of timing of PCC on 30-day readmissions and inpatient mortality. Design: Retrospective, observational study comparing risk-adjusted, observed-to-expected (O/E) 30-day readmissions and inpatient mortality among patients receiving inpatient PCC to all other inpatients. Setting/Subjects: Adult patients with hospital length of stay (LOS) <30 days, primary diagnoses of circulatory, infectious, respiratory, neoplasms, injury/poisoning, and digestive system were included from eight hospitals in a single health care system. Results: Compared with non-PCC patients (n = 43,463), PCC patients (n = 6043) had a greater proportion of African Americans, Medicare, LOS ‡7 days, intensive care unit stays, discharges to skilled nursing facility and hospice, primary diagnoses of infections and neoplasms, comorbidities of congestive heart failure, cancer, and dementia, Charlson comorbidity score ‡8 (p < 0.001), and fewer males (p = 0.03). Adjusted readmission reduction attributed to PCC among 0-2-, 3-6-, and 7-30-day subgroups was 14.1%, 19.2%, and 16.4%, respectively (usual care O/E = 0.904 vs. subgroup O/Es = 0.764, 0.713, 0.741, respectively). Adjusted mortality reductions attributed to PCC among the 0-2-and 3-6-day subgroups were 19.4% and 19.1%, respectively. A 12% mortality increase was observed in the 7-30-day subgroup (usual care O/E = 0.738 vs. subgroup O/Es = 0.544, 0.547, 0.858, respectively). Conclusions: Inpatient PCC reduces 30-day readmissions and inpatient mortality with the greatest impact demonstrated within six days of hospital admission. Early PCC should be encouraged for eligible patients.

Incidence and Characteristics Associated with Hospital Readmission after Discharge to Home Hospice

“…[9][10][11][12] However, there may be some reduction of readmission rates when the consult is initiated early in hospitalization, especially within the first six days. 19,20 We did not investigate palliative care consult by time. In addition, palliative care consultation was associated with greater patient satisfaction, increased hospice admission rates and length of stay, more deaths occurring at home, and decreased health care costs.…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument

“…On the other hand, when patients receive PC, their health and wellbeing is enhanced through improved pain relief, less dyspnea and depression, and enhanced quality of life, patient satisfaction and chances of dying at home [30][31][32][33][34][35]. Furthermore, psychological distress, decisional conflict, acute interventions or hospital readmissions are reduced [36][37][38][39], and quality of life for families is improved [40].…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation and content validity of a new interprofessional screening instrument.

“…These include, but are not limited to (i) excess hospital mortality -80% -when the majority of people wish to die at home (15,16); (ii) suboptimal symptom management (17)(18)(19); (iii) unplanned hospitalisations with long hospital stays (20,21); (iv) prescription of inappropriate treatments due to a lack of advance care planning (22,23); and, (v) insufficient support for the patient and their relatives (20,24,25). On the other hand, when patients receive PC, their health is enhanced with improved pain relief, less dyspnoea and depression, and enhanced quality of life, patient satisfaction and chances of dying at home (26)(27)(28)(29)(30)(31); psychological distress, decisional conflict, acute interventions or hospital readmissions are reduced (32)(33)(34)(35), and quality of life for families is improved (36). Step 1: determine the concept to measure.…”