Early Referrals: An Ideal Goal for Both Patient and Hospital (S775)

Abstract

•Recognize the patient characteristics associated with patients receiving an early palliative care referral.•Identify potential benefits to patients outcomes associated with receiving an early palliative care referral. A goal of palliative care (PC) is to move upstream in the course of illness and during hospitalization. Early consultation can resolve symptoms and address key decisions more quickly. Identify patient characteristics associated with early referrals to hospital PCS and the effects on patient outcomes. Eight PC-team members of the Palliative Care Quality Network (PCQN) entered data into the PCQN database from January 2013 to May 2014 resulting in 3,157 patient records. The 23-item PCQN dataset includes demographics, date of consult request, and symptoms. We then compared patient characteristics and outcomes to early (1-day after admission) and late referrals. Overall, 40% of referrals were early (n=1258). Early referrals were older (74 vs 70 years,p=0.0001) and more likely to be DNR/DNI (48% vs 40%). There was no association between early referral and diagnosis (p=0.3): cancer (41% early), neurologic (37%), pulmonary (37%), and cardiovascular (36%) disease. Fewer patients (p=0.0001) in ICUs received an early referral (29%) compared to telemetry/step-down (42%), and medical/surgical (39%) units. Palliative performance scale scores were similar for those with early and late consultations (mean 34 vs 32, p=0.2). More early referrals were discharged alive (75% vs 71%, p= 0.01) and referred to hospice (52% vs 46%, p=0.02). Early referrals had a shorter length of stay (LOS) after referral (mean 4.8 vs 6.3 days, p=0.02). Almost half of patients seen by the PCQN members are referred to PC early in their hospitalization. While patients referred early were older, just as sick and more likely to be DNR/DNI than those receiving a later referral, they were more likely to be discharged alive and to hospice.