Trends in Patient Care Costs and Utilization of an Established Acute Palliative Care Unit (733)

45 Background: Home death rate is increasingly being used as a quantifiable indicator of the effectiveness of palliative care services. Intensifying home care and training of the end-of-life care practitioners, seems to be the way to improve the correlation between patient preferences and actual place of death. The objective of this study is to measure the impact of a multidisciplinary home palliative care unit (HPCU) (including medical, nursery, and psycological care, and social worker counselling) on the place of death of patients treated in a single oncology service. Methods: A retrospective case-control study was performed. HPCU patients consecutively admitted from January 2014 to June 2015 (cases) were matched with contemporary patients from the same center who could be followed by independent support services (Home Hospitalization, Psicooncologists and General Practitioners) (controls) by diagnosis, sex, age group ( < 60 years, 61-75y and > 75y) and oncologist physician. Place of death was registered. Odds ratio (ORR) and relative risk was analysed with SPSS for Windows ver.22.00. Results: Seventy four patients (p) admitted in a HPCU and their controls were included; 54% men; Average of age in cases 69.7years (y) (SD 10.8) and controls 68.5 y (SD 10.41), diagnosed of lung cancer 20p (27%), breast cancer 6p (8%), gastrointestinal noncolorectal cancer 16p (22%), colorectal cancer 10p (13.5%), head and neck cancer 5p (6.8%), genitourinary cancer 12p (16%), metastatic melanoma 2p, advanced sarcoma 2p and unknown primary cancer 1p. Place of death: home (cases 43p [59%], controls 8p [10%]); emergency service (1p [1.4%] vs 3p [4.1%]); in acute hospital in-patient-care (AH) (11p [15.1%] vs 29 p [39.2%]) and at a hospitalized palliative care unit (18p [24.7%], vs 34p [45.9%]); 1p of case group was lost during follow-up. The ORR for dying at home for HPCU patients was 11.82 (IC 95% 4.95-28.02) and a reduction in risk of die in an AH was seen (0.38, IC 95% 0.21-0.67). Conclusions: Death at home seems to be more feasible if cancer diagnosed patients have a proper follow-up by a multidisciplinary home palliative care unit, and it also reduce the possibility of dying in an acute hospital in-patient-care.

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A High-Volume Specialist Palliative Care Unit and Team May Reduce In-Hospital End-of-Life Care Costs

Journal of Palliative Medicine ◽

10.1089/109662103322515202 ◽

2003 ◽

Vol 6 (5) ◽

pp. 699-705 ◽

Cited By ~ 168

Author(s):

Thomas J. Smith ◽

Patrick Coyne ◽

Brian Cassel ◽

Lynne Penberthy ◽

Alison Hopson ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

High Volume ◽

Palliative Care Unit ◽

Life Care ◽

Specialist Palliative Care ◽

Care Costs

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On the palliative care unit.

Families Systems & Health ◽

10.1037/fsh0000191 ◽

2016 ◽

Vol 34 (2) ◽

pp. 179-179

Author(s):

Peter A. Selwyn

Keyword(s):

Palliative Care ◽

Palliative Care Unit

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Medical Residents Needs on Communication Skills: What about after a Rotation in a Palliative Care Unit?

10.26226/morressier.5c76c8b4e2ea5a7237611f9b ◽

2019 ◽

Author(s):

Nuno Reis Carreira

Keyword(s):

Palliative Care ◽

Communication Skills ◽

Palliative Care Unit ◽

Medical Residents

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Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

BMJ Innovations ◽

10.1136/bmjinnov-2020-000557 ◽

2021 ◽

pp. bmjinnov-2020-000557

Author(s):

Sharon Rikin ◽

Eric J Epstein ◽

Inessa Gendlina

Keyword(s):

Palliative Care ◽

Infectious Diseases ◽

Patient Care ◽

Personal Protective Equipment ◽

Protective Equipment ◽

Qualitative Feedback ◽

The Usa ◽

New Challenges ◽

Science Framework ◽

Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

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Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211030443 ◽

2021 ◽

pp. 104990912110304

Author(s):

Amy Nolen ◽

Rawaa Olwi ◽

Selby Debbie

Keyword(s):

Palliative Care ◽

Acute Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Palliative Sedation ◽

Palliative Care Unit ◽

Care Hospital ◽

Medical Assistance ◽

Medical Assistance In Dying ◽

Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

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