Abstract
•Explain the growing role of informatics for proactive patient finding.•Describe the effect of the “trigger” list on inpatient palliative care volume, time to consult and hospital length of stay (LOS). Early palliative care (PC) intervention has been shown to reduce hospital length of LOS and readmissions. Use of informatics to proactively identify patients appropriate for PC consultation is one method to optimize PC involvement. The purpose of this study was to examine the impact of proactively identifying patients appropriate for palliative care consult upon hospital admission. Using informatics, a daily “trigger” list of patients admitted to the hospital medicine service in the last 24 hours who potentially meet PC criteria was sent to the PC team beginning in August 2014. Data was collected on all patients who met the “trigger” criteria and were admitted between January 2014 and June 2015. Consult volumes and time to consult in the seven months before (January 2014 – July 2014) and the 10 months after (August 2014 – June 2015) implementation of the “trigger” list were compared using t-tests. Length of stay was stratified by time to palliative care consult (<24, 24-72, and >72 hours) and compared using ANOVA. Mean number (standard deviation [SD]) of patients who met “trigger” criteria and received a PC consult significantly (p<0.05) increased from 9.8 (1.4) consults per month before the list was implemented to 31.9 (4.6) consults per month after the list was implemented. Mean time to consult decreased from 7.4 (3.2) days to 6.3 (1.8) days. Patients seen by the PC team within <24, 24-72, and >72 hours of admission had significantly (p<0.05) longer LOS the later they were seen by the PC team, 6.7 (0.3), 8.6 (0.5), and 18.1 (8.4) days, respectively. Use of informatics significantly increased the volume of PC consults and reduced the time to consult. Patients with later consults (>72 hours) had a 50% greater LOS compared to patients seen earlier.
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