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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

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 (

The authors declare no conflicts of interest.

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Accepted for publication: November 11, 2018

Published ahead of print: January 17, 2019

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