Disentangled: A single institutional analysis comparing differences in end-of-life patterns and resource utilization in acute leukemia and bone marrow transplant units.

Abstract

90 Background: The impact of palliative medicine in patients with hematologic malignancies is a growing area of investigation. Over the last year, the Palliative Medicine service at North Shore University Hospital (NSUH) has developed and sustained a co-management model for patients admitted to the acute leukemia (ALU) or bone marrow transplant (BMTU) units. Methods: The primary outcome measure was the time from admission to initial consult. The secondary outcome measure was length of stay in a goal concordant setting to receive end of life (EOL) care, namely our inpatient palliative care unit (PCU). Results: There were 106 new consults in twelve months (45 acute leukemia/lymphoma consults and 61 bone marrow transplant consults). The principal diagnosis seen on the ALU was acute myeloid leukemia (56%), whereas on the BMTU it was multiple myeloma (28%). The average time to consult for the ALU decreased from 18.8 days at 6 months to 8.8 days at 12 months. For the BMTU, time to consult decreased from 10.2 days at 6 months to 4.6 days at 12 months. The mortality rate of patients seen from the ALU and BMTU was 40% and 12%, respectively. Of the ALU population deaths, 83% were 65 or older, compared to 29% of the BMTU deaths. Mortality events in the ICU were greater for BMTU patients (43%) relative to ALU patients (11%). Fifty percent of the ALU inpatient expirations were able to receive EOL care in our PCU. The remaining deaths were in the ALU (39%) or ICU (11%). For BMT patients, 57% died on the BMTU, and 43% in the MICU. Despite comparable numbers of PCU transfers during the pre- and post-intervention period, our initiative increased the average LOS in the PCU from 1.1 to 5.7 days. Of the ALU patients electing DNR prior to death (83%), the average DNR-to-death days was 10.6 days, whereas BMTU patients who elected DNR prior to death (50%) had an average of 6.5 DNR-to-death days. Conclusions: This partnership allowed for recognition of differences in EOL care patterns across these populations. It has demonstrated a benefit by accelerating time to consult and enhancing transitions to goal concordant settings for patients with hematologic malignancies at the end of their lives.