Abstract W MP107: Palliative Care Referrals are Under-used

Abstract

Introduction: The National Institutes of Health Stroke Scale (NIHSS) is a well-validated predictor of 90-day functional outcomes. A score of ≥16 forecasts a high probability of death or severe disability. The palliative care (PC) needs of patients with serious or life-threatening stroke are enormous. Per PC standards and the American Stroke Association’s position statement on PC after stroke, customized PC should be available to patients and their families throughout the entire course of illness. Palliative care can be initiated in the hospital setting without limitations on life expectancy. The purpose of this project was to quantify NIHSS scores on admission compared to the percent of PC referrals made at 3 urban hospitals that use neurological pre-formatted orders, and have in-patient PC programs. Hypothesis: We hypothesized that In-patient PC referrals for stroke patients with NIHSS scores of ≥16 are low, in the context of pre-formatted orders that set the referral trigger at ≥ to 25. Methodology: Ischemic and hemorrhagic stroke cases discharged from Nov. 1, 2013-May 31, 2014 were reviewed retrospectively (674 total). NIHSS assessments were scored by stroke-certified RN staff on admission. Excluded were patients whose full NIHSS score was not documented, patients referred directly to hospice, and patients who left Against Medical Advice. Cases were examined for NIHSS score, and whether or not they were referred to PC. Results: Of 615 qualifying patients, 51 (8.3%) were referred for PC during their in-patient stay. The percentage with a NIHSS score on admission </= 6, was 3.5% (11/313). At a score of 7-15, 7.8% (15/188) received referrals. At scores ≥ 16, 21.9% (25/114) were referred. Conclusion: While the poor 90-day outcomes for patients with NIHSS scores ≥ 16 have been well-validated, just under 22% of the patients in this study received in-patient referrals to palliative care. Previously conducted studies relating NIHSS scores and 90-day outcomes suggest that there is an opportunity to improve the quality of life for more of these patients and their families through increased palliative care referrals.