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Symptom Assessment and Hospital Utilization in a Home-Based Palliative Care Program

Rotter, Briana, DNP, APRN, FNP-C; Grant, Marian, DNP, CRNP, ACHPN, FPCN, RN

Journal of Hospice & Palliative Nursing: August 2018 - Volume 20 - Issue 4 - p 332–337
doi: 10.1097/NJH.0000000000000448
Symptom Management Series

Palliative care delivery is shifting to the home, yet data are limited on symptom assessment tools and protocols for that setting. A quality improvement project was done in a home-based palliative care program to imbed the Edmonton Symptom Assessment System into the electronic health record. The purpose of the quality improvement project was to track symptom severity and collect utilization data. Baseline data were collected on 35 patients for symptom presence and severity as well as hospital utilization and readmission. The most common symptoms were tiredness, pain, and a lack of feeling of overall well-being. The most severe symptoms, those with a rating of 6 of 10 or higher, were pain, drowsiness, and anxiety. Seventy-seven percent of the symptoms within the Edmonton Symptom Assessment System showed an improvement over the 3-month QI project per the electronic health record data. Hospitalization rates also went from 4.2% to 2.6% and 30-day readmissions were reduced from 15% to 0%. The results suggest that the palliative care program was able to improve symptoms through the use of Edmonton Symptom Assessment System and that that may have affected hospital utilization.

Briana Rotter, DNP, APRN, FNP-C, is assistant professor, School of Nursing, University of Portland, Oregon.

Marian Grant, DNP, CRNP, ACHPN, FPCN, RN, is policy consultant, Marian Grant Consulting, Washington, DC.

The authors have no conflicts of interest to disclose.

Address correspondence to Briana Rotter, DNP, APRN, FNP-C, 5000 N Willamette Blvd, Portland, OR 97203 (

© 2018 by The Hospice and Palliative Nurses Association.