Palliative Care Team Perceptions of Standardized Palliative Care Referral Criteria Implementation in Hospital Settings

Heitner, Rachael; Rogers, Maggie; Silvers, Allison; Courtright, Katherine R.; Meier, Diane E.

doi:10.1089/jpm.2020.0296

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…26 It is also important to note that in a national survey of 53 palliative care programs that standardized referral criteria, increased palliative team workload and inappropriate consults were noted as disadvantages and potential burdens on the palliative providers. 27 The pattern of referring services appeared to change in this project with the implementation of the screening process and alert with a shift in the number of referrals from different medical teams and services. The change in pattern revealed a statistically significant increase in oncology referrals and a decrease in unknown services as well as a marginally significant increase in surgery.…”

Section: Discussionmentioning

confidence: 95%

“…Another project that occurred in the ICU at an academic medical center noted that 80.1% of patients who met the criteria on the screening tool were not referred to palliative care 26 . It is also important to note that in a national survey of 53 palliative care programs that standardized referral criteria, increased palliative team workload and inappropriate consults were noted as disadvantages and potential burdens on the palliative providers 27 …”

Section: Discussionmentioning

confidence: 99%

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

Haranis

Lampkin

Roche-Green

et al. 2023

J Hosp Palliat Nurs

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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.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

Haranis

Lampkin

Roche-Green

et al. 2023

J Hosp Palliat Nurs

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show abstract

“…Low or late referrals stem, in part, from clinicians serving as gatekeepers: under usual care, clinicians must identify patients likely to benefit from palliative care and choose to order a consult. Because even experienced clinicians struggle to determine who will benefit from palliative care, many health systems have developed referral criteria . However, it is unknown whether such “trigger” approaches or other interventions designed to increase palliative care delivery change the frequency or timing of palliative care or affect patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Because even experienced clinicians struggle to determine who will benefit from palliative care, [18][19][20] many health systems have developed referral criteria. 21 However, it is unknown whether such "trigger" approaches or other interventions designed to increase palliative care delivery change the frequency or timing of palliative care or affect patient outcomes.…”

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confidence: 99%

Default Palliative Care Consultation for Seriously Ill Hospitalized Patients

Courtright,

Madden,

Bayes

et al. 2024

JAMA

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ImportanceIncreasing inpatient palliative care delivery is prioritized, but large-scale, experimental evidence of its effectiveness is lacking.ObjectiveTo determine whether ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increased consultations and improved outcomes.Design, Setting, and ParticipantsA pragmatic, stepped-wedge, cluster randomized trial was conducted among patients 65 years or older with advanced chronic obstructive pulmonary disease, dementia, or kidney failure admitted from March 21, 2016, through November 14, 2018, to 11 US hospitals. Outcome data collection ended on January 31, 2019.InterventionOrdering palliative care consultation by default for eligible patients, while allowing clinicians to opt-out, was compared with usual care, in which clinicians could choose to order palliative care.Main Outcomes and MeasuresThe primary outcome was hospital length of stay, with deaths coded as the longest length of stay, and secondary end points included palliative care consult rate, discharge to hospice, do-not-resuscitate orders, and in-hospital mortality.ResultsOf 34 239 patients enrolled, 24 065 had lengths of stay of at least 72 hours and were included in the primary analytic sample (10 313 in the default order group and 13 752 in the usual care group; 13 338 [55.4%] women; mean age, 77.9 years). A higher percentage of patients in the default order group received palliative care consultation than in the standard care group (43.9% vs 16.6%; adjusted odds ratio [aOR], 5.17 [95% CI, 4.59-5.81]) and received consultation earlier (mean [SD] of 3.4 [2.6] days after admission vs 4.6 [4.8] days; P &lt; .001). Length of stay did not differ between the default order and usual care groups (percent difference in median length of stay, −0.53% [95% CI, −3.51% to 2.53%]). Patients in the default order group had higher rates of do-not-resuscitate orders at discharge (aOR, 1.40 [95% CI, 1.21-1.63]) and discharge to hospice (aOR, 1.30 [95% CI, 1.07-1.57]) than the usual care group, and similar in-hospital mortality (4.7% vs 4.2%; aOR, 0.86 [95% CI, 0.68-1.08]).Conclusions and RelevanceDefault palliative care consult orders did not reduce length of stay for older, hospitalized patients with advanced chronic illnesses, but did improve the rate and timing of consultation and some end-of-life care processes.Trial RegistrationClinicalTrials.gov Identifier: NCT02505035

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An Update: National Institutes of Health Research Funding for Palliative Medicine 2016–2020

Buehler,

Frydman,

Morrison

et al. 2023

Journal of Palliative Medicine

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Palliative Care Team Perceptions of Standardized Palliative Care Referral Criteria Implementation in Hospital Settings

Cited by 5 publications

References 12 publications

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

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

Default Palliative Care Consultation for Seriously Ill Hospitalized Patients

An Update: National Institutes of Health Research Funding for Palliative Medicine 2016–2020

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