PALLIATIVE CARE INVOLVEMENT FOR COMMUNITY HOSPITAL TRANSFERS TO THE MEDICAL ICU IN A TERTIARY CARE CENTER: A RETROSPECTIVE REVIEW

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Critically ill patients are often transferred from community hospitals to medical intensive care units(MICU) at tertiary care centers for advanced therapies. Recently, studies have shown that limiting life-sustaining treatment with early palliative care and hospice referrals in intensive care units reduce over-utilization of scarce resources. We hypothesized that community hospital transfers had low rates of palliative care consultations and hospice referrals that result in higher utilization of MICU resources. METHODS: A single-center study, retrospective chart review of 472 patients transferred from community hospitals to the MICU between 2016 to 2018 in a tertiary care center was conducted. We investigated the proportion of outside hospital transfers who received palliative consults and analyzed effect of the consult on overall outcome, length of stay, and resource utilization. RESULTS: Of the 472 patients analyzed, 56% were women and 33% were African American. The mean age was 58 years old and ranged between 19 to 87 years. The mean length of stay for all patients was 15 days and ranged between 1 and 205 days. The mean hospitalization cost was $77,185. Of the 472 patients, 324 patients expired and 6% were discharged to hospice. Palliative care was consulted for 30% of all patients during hospitalization, and of those patients, 12.7% were referred and discharged to hospice. Of those patients who did not receive palliative care consults, only 3% were referred and discharged to hospice. Of 141 patients who had palliative care consults placed regardless of outcome, 60% of consults were placed more than 7 days after admission. Approximately 67 patients, of the total 472 patients, expired within 48 hours of transfer. From the 257 patients that survived past 48 hours, 61% had no palliative care consult placed and 27% of patients had consults placed at least seven days after transfer. The time to palliative care consultation had a positive correlation with the length of hospitalization with r=0.79 and with hospitalization cost with r=0.75. CONCLUSIONS: There is a high mortality rate associated with patients transferred from community hospitals to tertiary care centers regardless of initial diagnoses. However, only 30% of all patients were evaluated by palliative care with most consultations placed later in the hospitalization which correlated with longer lengths of stay and hospitalization costs. When palliative care was consulted, there were higher percentage of patients referred to hospice compared to those without palliative care consults placed. CLINICAL IMPLICATIONS: Early involvement of palliative care for outside hospital transfers at tertiary care centers is crucial for optimization of resources and improving patient outcomes in the MICU. DISCLOSURES: No relevant relationships by Majed Alnabulsi, source=Web Response No relevant relationships by Michelle Lee, source=Web Response No relevant relationships by Kiran Motwani, source=Web Response No relevant relationships by Xinyuan Ning, source=Web Response No relevant relationships by Sonika Patel, source=Web Response No relevant relationships by Emily Xiao, source=Web Response