University Hospital, Newark, NJ
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Palliative Care and End of Life
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM
PURPOSE: In recent years, ICU use and health care utilization has increased at the end of life. We studied the trend in palliative care consults (PCC) in a university hospital in non-ICU setting and its correlation with hospital stay.
METHODS: We retrospectively reviewed the charts of all patients admitted to medicine floors at University Hospital in May 2015. Patients admitted to ICU within 24 hours of admission were excluded. 461 patient charts were screened for PCC based on the consensus report from the Center to Advance Palliative Care (CPAC). Criteria for PCC on admission included a life limiting diagnosis and one of the following: >1 admission for the same condition in the last three months, decline in function or complex care requirements. If patients did not meet criteria for PCC on admission, the files were screened for meeting PCC indication during hospital stay, which included life limiting diagnosis and one of three conditions: uncertainty about medical decisions, ICU stay >7 days or lack of goals of care. Demographic data, baseline clinical characteristics and hospital stay indicators were collected for analysis. Chi-square test and binary logistic regression were used for statistical analysis.
RESULTS: Of the studied population, 28.6% (n = 132) met indication for PCC. 45% were females, 40% were African American and 21% Hispanic. The mean age was 59±14 years. The average length of stay was 7±7 days. Of the patients who met criteria for PCC only 26.5% (n=35) received one. There were comparable rates of PCC among teaching and non-teaching services. Patients with diagnosis of metastatic cancer were more likely to get a PCC than non cancer patients (64% vs. 21%; p<0.001). Patients with CHF NYHA Class 3 or 4 were less likely to get PCC compared to patients without CHF (5.6% vs. 29.8%; p .014). On univariate analysis, patients who received a PCC were 10 times as likely to have their code status changed to DNR/DNI (p<0.001). On multivariate analysis, patients with PCC within 48 hours of admission were 20 times as likely to have a length of stay < 7 days (p 0.017). There was a trend of decreased 30-day readmission rate in those who received a PCC compared to those who did not (26% vs. 33% p 0.447).
CONCLUSIONS: Significant percentage of patients who meet criteria for PCC do not receive a consult during their hospital stay. Early PCC may reduce hospital length of stay and aid in establishing goals of care.
CLINICAL IMPLICATIONS: Further education of healthcare providers is needed for appropriateness and timing of palliative care consults in non-cancer patients admitted to the hospital. Early palliative care consults may lead to reduction in length of hospital stay, readmission rates and health care costs.
DISCLOSURE: The following authors have nothing to disclose: Mohleen Kang, Nisha Suda, Hussam Eltoukhy, Sejal Kothadia, Komal Patel, Yulanka Castro Dominguez, Richard May, Susanne Walther, Neil Kothari, Mirela Feurdean, Anne Sutherland
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