Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T07:24:21.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and implementation of a palliative care consultation tool

Published online by Cambridge University Press:  22 March 2012

Alexei Trout ,
Kenneth L. Kirsh  and
John F. Peppin
Alexei Trout
Affiliation:
St. Joseph's Hospital, Continuing Care Hospital, Lexington, Kentucky
Kenneth L. Kirsh
Affiliation:
The Pain Treatment Center of the Bluegrass, Lexington, Kentucky
John F. Peppin*
Affiliation:
St. Joseph's Hospital, Continuing Care Hospital, Lexington, Kentucky The Pain Treatment Center of the Bluegrass, Lexington, Kentucky The Palliative Care Service, Hospice of the Bluegrass, Lexington, Kentucky
*
Address correspondence and reprint requests to: John F. Peppin, Clinical Research Division, The Pain Treatment Center of the Bluegrass, 2416 Regency Road, Lexington, Kentucky 40503. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Palliative care services are becoming more commonplace in hospitals and have the potential to reduce hospital costs through length of stay reduction and remediation of symptoms. However, there has been little systematic attempt to identify when a palliative care consultation should be triggered in a hospital, and there is some evidence that these services are under-utilized and not fully understood.

Method:

In an initial attempt to address when a consultation might be appropriate, we attempted to pilot test a novel palliative care screening tool to help guide clinician judgment in this regard. A one-page, face-valid instrument was developed using expert opinion.

Results:

The sample comprised 33 men (44.6%) and 41 women (55.4%) with an average age of 63.4 years (SD = 13.8) and an average length of stay of 22.7 days (SD = 10.1). The most significant symptom was pain, indicated as moderate-to-severe in 23 patients (31%). This was followed by fatigue (n = 10, 13.5%) and nausea (n = 6, 8.1%). At unit entry, 20 patients (33%) had moderate or severe pain. Upon discharge, this number had been reduced to 12/60 (20%). Chi-Square analysis showed a significant decrease in pain rankings overall (χ2 = 36.3, p < 0.0001). The average total tool score was 7.5 (SD = 3.1). Using an initial threshold of 12 to trigger a palliative care referral, 64 patients (86.5%) would not have received a referral and 10 (13.5%) would have. Of these 10 patients, 2 (20%) did not receive a palliative care consultation while they were hospitalized.

Significance of results:

The tool we developed increased consultations over the time period in which it was used, compared with the same time period 1 year prior. Although the threshold developed for triggering referrals seemed artificially high, the implementation of the screening tool did increase referrals.

Keywords

Palliative careConsultationPain
Type
Original Articles
Information
Palliative & Supportive Care , Volume 10 , Issue 3 , September 2012 , pp. 171 - 175
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Academy of Hospice and Palliative Medicine. (2011). http://www.aahpm.org/about/default/college.html.Google Scholar
Center to Advance Palliative Care. (2011). Palliative Care Defined. http://www.capcmssm.org/palliative-care-defined.html (Accessed on February 2012).Google Scholar
Ciemens, E., Blum, L., Nunley, M., et al. (2007). The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach. Journal of Palliative Medicine, 10, 1347–1355.CrossRefGoogle Scholar
Grant, M., Elk, R., Ferrell, B., et al. (2009). Current status of palliative care clinical implementation, education, and research. CA: A Cancer Journal for Clinicians, 59, 327–335.Google ScholarPubMed
Ho, L.A., Engelberg, R.A., Curtis, J.R., et al. (2011). Comparing clinician ratings of the quality of palliative care in the intensive care unit. Critical Care Medicine, 39, 975–983.CrossRefGoogle ScholarPubMed
Morrogh, M., Miner, T.J., Park, A., et al. (2010). A prospective evaluation of the durability of palliative interventions for patients with metastatic breast cancer. Cancer, 116, 3338–3347.CrossRefGoogle ScholarPubMed
National Council for Palliative Care. (2012). Palliative care explained. http://www.ncpc.org.uk/palliative_care.html.Google Scholar
O'Mahony, S., Blank, A.E., Zallman, L., et al. (2005). The benefits of a hospital-based inpatient palliative care consultation service: Preliminary outcome data. Journal of Palliative Medicine, 8, 1033–1039.CrossRefGoogle ScholarPubMed
Palliative Care Foundation. (2012). http://foundation.palliativecare.org.au/about_palliative.asp.Google Scholar
Passik, S.D., Ruggles, C., Brown, G., et al. (2004). Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program? Palliative & Supportive Care, 2, 419–423.CrossRefGoogle Scholar
Penrod, J., Deb, P., Luhrs, C., et al. (2006). Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. Journal of Palliative Medicine, 9, 855–860.CrossRefGoogle ScholarPubMed
Rodriguez, K., Barnato, A. & Arnold, R. (2007). Preceptions and utilization of palliative care services in acute care hospitals. Journal of Palliative Medicine, 10, 99–110.CrossRefGoogle Scholar
Schuurman, N., Crooks, V.A. & Amram, O. (2010). A protocol for determining differences in consistency and depth of palliative care service provision across community sites. Health & Social Care in the Community, 18, 537–548.CrossRefGoogle ScholarPubMed
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 263, 733–742.CrossRefGoogle Scholar
Walshe, C., Chew-Graham, C., Todd, C., et al. (2008). What influences referrals within community palliative care services? A qualitative case study. Social Science & Medicine, 67, 137–146.CrossRefGoogle ScholarPubMed
World Health Organization. (2012). WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/ (Accessed on February 2012).Google Scholar