Abstract 10311: Increasing Inpatient Palliative Care Referrals for Veterans with Heart Failure: A Quality Improvement Initiative

Abstract

Background: Heart failure (HF) portends significant morbidity and mortality. Integrating palliative care (PC) with HF management may improve quality of life, communication, and preparedness planning. At the VA hospital in West Haven, CT, PC was utilized in 6.5% of patients admitted with HF from October 2019 to September 2020. We sought to increase the percentage of referrals to PC from 6.5% to 20% by May 2021. Methods: PC referral criteria were developed and used to screen all patients admitted to the medical service with HF between October 2020 and May 2021. Patient-centered education on the benefits of PC was delivered initially to medical teams caring for patients who met PC referral criteria and subsequently to all teams. Changes were tested using Plan-Do-Study-Act (PDSA) cycles. Results were analyzed using run charts. Results: Between November 2020 and May 2021, there were 109 HF admissions in patients who were not already followed by PC. Thirty-one (28%) received a new PC consult. The mean age was 83 ± 9.5 years, median B-type natriuretic peptide was 1202 pg/mL, and mean hospital length of stay was 8 ± 5 days. Kansas City Cardiomyopathy Questionnaire-12 was performed on 15 of the 31 patients with a mean score of 60 ± 22. After our intervention, a shift in the percentage of referrals was demonstrated with 6 consecutive data points above the fixed baseline median (Figure). During the index hospitalization, 5 patients died, 4 of whom had a PC consult. Conclusion: Through multiple PDSA cycles, referrals to PC for patients admitted with HF increased from 6.5% to 28%. Patient-centered education was an effective tool to teach medical teams about the benefits of PC. Furthermore, inpatient teams more consistently and independently considered PC for patients with HF, representing a cultural shift. This Quality Improvement model may serve as a paradigm to improve the care of HF patients.