Comparisons Between Palliative Care Consultation Services in California Hospitals From 2007 to 2011 (SA528-C)

Abstract

Objectives 1. Compare changes in staffing, availability, and patient volume of palliative care consultation services between 2007 and 2011. 2. To discuss aspects of palliative care consultation services that have improved or not improved between the two study periods. Background. The number of palliative care consultation services (PCCS) is growing, yet little is known about how program structure and characteristics change over time. Research Objectives. Compare changes in availability, staffing, and patient volume among palliative care consultation services (PCCS) in California hospitals from 2007 to 2011. Method. We surveyed all acute care hospitals in California regarding PCCS in 2007 and 2011. Result. Response rates were 92% (324/351) in 2007 and 96% (361/377) in 2011. There were 26 additional PCCS in 2011 (133) vs. 2007 (107) but no change (p 1⁄4 .4) in overall prevalence: 33% in 2007 vs. 36% in 2011. At both time periods the majority of PCCS (98%) were available onsite during weekday business hours and only half were available during weekend daytime hours (p 1⁄4 .4). There was an increase (p 1⁄4 .002) in nurse/physician FTE (2007: mean 1⁄4 1.5; 95% CI 1⁄4 1.3, 1.7; 2011: mean 1⁄4 1.9, 95% CI1⁄41.6, 2.2), and no change (p 1⁄4 .8) in the number of patients seen per nurse/physician FTE in 2007 (mean1⁄4258, 95% CI1⁄4223,293) and 2011 (mean 1⁄4 265, 95% CI 1⁄4 229,300). Half of PCCS reported seeing fewer than half of patients who would benefit from a consultation (2007 1⁄4 59%, 2011 1⁄4 50%, p 1⁄4 .2), yet the majority also reported struggling to cope with patient volume (2007: 62%; 2011: 66%, p1⁄4 .5). In both surveys, the number of patients per nurse/physician FTE was higher (p 1⁄4 .005) for teams struggling to cope (mean 1⁄4 290, 95% CI 1⁄4 260, 321) compared to those that were not (mean 1⁄4 215, 95% CI 1⁄4 170,260). Conclusion. Despite increased staffing, still only a minority of PCCS have 24/7 availability and most report struggling to cope despite seeing fewer than half of appropriate patients. Implications for Research, Policy, or Practice. Increased staffing is needed to allow hospital PCCS to adequately meet patient needs.