Quality Palliative Care and the First Domain

A Quality Assessment and Performance Improvement Project

Abstract

The first domain of the Clinical Practice Guidelines for Quality Palliative Care includes a commitment to quality assessment and performance improvement. This article describes a quality assessment and performance improvement process initiated in November 2012 to reduce the potentially preventable readmissions (PPRs) of those persons seen by the palliative care (PC) consult service. The goal was to reduce PPRs from 15.7% to 13%. Furthermore, the project identified a more upstream population using a novel set of criteria and was found to be appropriate for PC consults. Key performance markers for a quality PC consult became the process goals guiding new consistent interventions. In response to the findings of this project, a busy, short-staffed PC team changed its daily work strategy for seeing new consults and demonstrated in measurable terms the impact of PC by reducing the PC team PPR from 15.7% to 6.3%. This dramatic change illustrated the potential for cost savings through consistent interventions. Inadequate staffing was a barrier to the ongoing success of this project when the team could not see all the ordered consults. If limited staffing issues are addressed, quality inpatient PC consults could be the answer to reducing the burden of readmissions and address the financial burden to persons and their families as well as to the health care system and rising health care costs.