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Interdisciplinary Rounds on a Hospitalist Service

Impact on Palliative Care Measures, Quality, and Utilization Outcomes

Smith, Catherine V. DNP, RN, CCNS, CCRN; Maduro, Ralitsa S. PhD; Morgan, Merri K. DNP, RN, CCRN; Ver Schneider, Patricia; Rutledge, Carolyn M. PhD, FNP-BC; Zimbro, Kathie S. PhD, RN

doi: 10.1097/NCQ.0000000000000385
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Background: Despite growth in service availability, palliative care (PC) referrals are often underutilized or delayed, which may compromise patient outcomes.

Local Problem: Underutilized or delayed PC referrals among hospitalized adults prompted this project aimed at improving PC measures, quality, and utilization outcomes.

Methods: Data extracted from the electronic medical record were used to identify needed improvements in PC.

Intervention: Interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting.

Results: Following implementation, median time to PC referral decreased by 2 days. Length of stay (LOS), direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility.

Conclusions: Results support IDRs as a mechanism to improve time to PC referral, decrease LOS, direct cost, and 30-day mortality among hospitalized adults. A more objective method of identifying patients with unmet PC needs may be warranted.

Nursing Administration, Sentara Williamsburg Regional Medical Center, Williamsburg, Virginia (Dr Smith); Quality Research Institute, Sentara Healthcare, Virginia Beach, Virginia (Drs Maduro, Morgan, and Zimbro and Ms Schneider); and School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Rutledge).

Correspondence: Catherine V. Smith, DNP, RN, CCNS, CCRN, SWRMC Nursing Administration, 100 Sentara Circle, Williamsburg, VA 23188 (cvsmith2@sentara.com).

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jncqjournal.com).

Accepted for publication: November 11, 2018

Published ahead of print: January 17, 2019

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