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Effect of a Palliative Screening Tool on Referrals

An Approach to Increase Access to Palliative Care Services

Kichler, Casie M., DNP; Cothran, Fawn A., PhD; Phillips, Marcia A., PhD

Journal of Hospice & Palliative Nursing: December 2018 - Volume 20 - Issue 6 - p 548–553
doi: 10.1097/NJH.0000000000000475
Feature Articles

The aim of this study was to develop and trial a screening tool to increase palliative care referrals for hospitalized patients with chronic obstructive pulmonary disease (COPD) at a community hospital. Baseline data were collected retrospectively to determine the palliative care referral rate of patients with COPD at a high risk for readmission using the LACE index. A palliative care referral tool was developed to screen the patients who were at a high risk for readmission for palliative care referral. A 3-month pilot project prospectively evaluated the palliative care referral rate after educating staff on the use of the screening tool and implementing its use. During the baseline study, 2 palliative care referrals were placed out of 19 patients who were deemed appropriate by the screening tool (10.5%). During the pilot project, 16 palliative care referrals were placed out of 45 patients who were deemed appropriate by the screening tool (35.6%). Emergency room visits and readmissions were not significantly different between those with palliative referrals and those without. Barriers to palliative care referral were explored. The improvement in palliative care referrals, which occurred after the introduction of the consensus-driven screening process for patients with COPD, suggests the possibility of improved patient care using this model.

Casie M. Kichler, DNP, is director of clinical effectiveness, Norton Healthcare, Louisville, Kentucky.

Fawn A. Cothran, PhD, is assistant professor, Family Caregiving Institute, Sacramento, California.

Marcia A. Phillips, PhD, is assistant professor, Rush University, Chicago, Illinois.

Address correspondence to Casie M. Kichler, DNP, 10720 Eagle Ridge Pl, Louisville, KY 40223 (

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.