The Impact of a Palliative Care Consult Service on Patient Code Status and Discharge Outcomes (702)

Abstract

Objectives 1. Discuss Palliative Care Consult Service functions with regard to Advance Directives and provider documentation of code status. 2. Describe the transition from full code to full medical management to comfort care only. 3. Explain the relationship between code status, discharge planning, and outcome. I. Background. Hospital inpatient Palliative Care Consult Services (PCCS) assist patients and families in establishing goals of care; arranging for continued medical care; and discharge consistent with those goals. Outcomes commonly include advance directives or DNR orders. II. Research Objectives. This study examines the impact of palliative care consults on changes in patient code status and discharge outcomes. III. Methods. Data were obtained from the PCCS administrative database on a sample of patients for whom code status change was documented. Descriptive statistics were conducted on reasons for the consult, code status changes, days between consult and code status change, and discharge outcomes. IV. Results. Code status changed to Comfort Care Only (CCO) for 539 patients; 46% from DNR CCA (a designation specific to Ohio, which requires full medical management until cardiorespiratory arrest at which time CCO takes effect) and 54% from full code. End-of-life issues were the reason for 75% of consults. Discharge status for 71% was death and for 18% hospice care. Code status changed on average 2.2 days after consult, 51% occurring on the same day. There were 435 patients who became DNR CCA; 428 (98%) were full code when the consult was requested. End-of-life issues was the reason for 67% of consults and establish goals of care for 16%. Discharge status for 47% was death and for 22% hospice care. Code status changed on average 1.4 days after consult, 62% occurring on the same day. V. Conclusion. The PCCS facilitates establishing goals of care and initiates appropriate care for patients with advanced disease. Many PCCS requests involve helping dying patients and families with end-of-life issues, resulting in code status changes and/or hospice enrollment. VI. Implications for Research, Policy, or Practice. A hospital inpatient PCCS supports patients and families facing end-of-life decisions and care, helping assure that patients receive medically appropriate care that is consistent with their goals.