Trends in Utilization of Palliative Care by General Surgery Services (S770)

Abstract

•Evaluate the trends for consults to Palliative Medicine by surgical services.•Evaluate the end of life care for surgical patients over time. Palliative Care (PC) focuses on symptom relief and quality of life improvement for patients, but it is often thought to be synonymous with end-of-life (EOL) care. The America Board of Surgeons has endorsed the incorporation of palliative principles into surgical care. To determine the trends of utilization of Palliative Care consultation by surgical services over time. A single institution retrospective chart review was utilized from 2006-2013. Patients on inpatient surgical service (general, vascular, cardiothoracic, transplant surgery) and who had a PC consult were identified. Charts were evaluated for patient demographics, admission and medical/surgical information, consult reason and disposition. Of the 358 consults the majority of the diagnoses were cancer-related (47.5%), 13.4% cardiac-related, and 13.7% vascular-related. The main reasons for PC consultation were clarifying goals of care, EOL issues and symptom management, with an increase in the number of consults over time. Discharge disposition included 30.2% dying in hospital, 17.3% to home hospice, 12.0% to hospice, and the remainder to home or rehab. 46.3% of the patients who died in hospital had a PC consult within a day of death. Since the initiation of a Palliative Care consult service at our hospital there has been an increase in the utilization of their services by surgical services. The main reason for consultation has been for goals of care and EOL care with an increase in consultation for assistance with symptom management. There continues to remain a significant portion of patients who died in the hospital with a significant portion of the consults placed late in the hospital course, specifically within a day of death.