University of California Irvine Medical Center
Introduction: The greatest amount of money is spent in the last two months of life, with many people in advanced countries spending that time in the hospital. This is where palliative medicine, a specialty that, utilizing a multidisciplinary approach to relieve the suffering of patients, can play a significant role. We evaluated patients near end of life in order to assess if a palliative care consult for patients meeting screening criteria could reduce utilization of intensive care and length of hospitalization while providing comfort and relief until time of death.
Hypothesis: Patients who received a palliative care consult based on screening criteria earlier in their hospital stay will yield an overall decrease in hospital Length of Stay (LOS).
Methods: A retrospective review was completed for all patients who expired in the hospital within a 1.5 year period. The eligible patients were any inpatient hospitalized for greater than 48 hours and expired in the hospital. Demographics, diagnosis, ICU and hospital LOS, discharge location, and total number of consults were noted. Unpaired t-test and p-value were calculated for statistical analysis.
Results: Out of the 361 patients whose charts were reviewed, 243 (67%) received a palliative care consult and 118 (33%) did not. Patients not consulted by palliative care, met criteria on day 1.58 with an average hospital LOS of 14.48 days, while those who did receive a palliative care consult met criteria on day 1.02 with an average hospital LOS of 16.39 days. Those patients, however, did not receive consults until day 9.32. Initial analysis of LOS showed no difference (p= 0.3744). However, if time to consult was subtracted, a clear difference in LOS(p<0.01) was noted. Additionally, patients who had been consulted by palliative care spent an average of 8.86 extra days in the ICU, rather than being transferred to a step down unit.
Conclusions: Providing patients, who meet criteria, with palliative care service earlier in their hospital stay, will result in a decrease in the patient’s overall LOS, saving them precious time, while providing appropriate comfort measures. Furthermore, economic and resource savings can be achieved while still providing improved care to the patient.