Abstract NS22: Palliative Care in the Stroke Patient

Abstract

Background and Purpose: Palliative and end of life care are gaining importance in the healthcare environment. Palliative care and hospice may be underutilized in this population. Evaluation of current process will determine opportunities for improvement. Methods and Results: Retrospective review of patients admitted over one year with the diagnosis of acute ischemic stroke (AIS) and hemorrhagic stroke was completed, assessing 575 records. This population included 491 AIS and 84 hemorrhages. Eighty-one AIS patients received t-PA. Discharge status distribution included: 269 to home; 114 to acute rehabilitation; 123 to skilled nursing facilities (SNF); 29 to hospice; and 42 died. Fifty-five patients had comfort care orders prior to discharge: 32 by hospital day two, 23 by hospital day three or later. AIS patients with comfort care orders had an average NIHSS of 17; hemorrhagic stroke patients had an average GCS of 5. Patients with comfort care orders were an average age of 72 years with equal distribution (AIS = 27; hemorrhage = 28) and gender (25 male, 30 female); majority were Caucasian (3 African American, 1 Latino, 1 Asian). Twenty patients with similar characteristics were discharged to SNF with no discussion of palliative care or hospice. A review of records revealed provider disagreement for long-term prognosis as a significant barrier to patient/family decisions regarding end of life choices, or supporting choices made by patients/family opting for palliative care. Conclusions: Based on these data, a palliative care nurse joined the stroke team, and the stroke coordinator joined the palliative care committee to assist in these conversations. Palliative care training for providers is on-going in the acute care setting, while outpatient providers are being engaged in utilizing The Iowa Physician Order for Scope of Treatment (IPOST).This document was designed to promote community care coordination and advanced care planning, in order to provide seamless communication and execution of individual care choices across the healthcare continuum. As these strategies are implemented, an increase in end of life planning is anticipated.