Inpatient Palliative Care Team Research Articles

Survival, Mortality, and Location of Death for Patients Seen by a Hospital-Based Palliative Care Team

Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. The team provided consults to 292 unique patients: 60% were younger than age 65, 39% were female, and 16% were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37% died in hospital and 63% were discharged alive, either to home (54%), nursing facilities (20%), or inpatient hospice (26%). Of the 183 patients discharged alive, 38% died within 2 weeks, 32% died between 2 weeks and 6 months, 25% were alive at 6 months, and 4% were unknown. Of note, only 10% of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5% of those discharged alive from OHSU ultimately died in an acute care hospital. We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning--allowing even patients very near death to leave the hospital if they wish.

The delivery of palliative care

Specialist palliative care services are now widespread throughout the U.K. There exist over 200 specialist inpatient hospices and many more palliative care teams in acute hospitals and in the community. Nearly all are headed by one or more doctors who are specialists in palliative medicine. However, such specialists are thinly spread and it is essential to ensure that there is wise use of this scarce and expensive resource. In an area of north-east England that has a completely integrated Specialist Palliative Care Unit (SPCU), giving an advisory service in acute hospitals and in the patients’ homes, as well as day hospice, inpatient hospice, research and education facilities, two aspects of the palliative specialist’s work were studied. Advisory visits to homes and the acute hospitals, which were done at the request of the specialist or the general practitioner, were studied for 3 months. Doctors, nurses, patients and relatives were questioned 1 week after the consultation, aiming to discover whether the visit had been prompt, helpful and effective. The palliative medicine specialist who made the visit was also asked whether the intervention had been effective, whether it had resulted in admission of the patient from home to hospice or hospital, and whether the visit had given him a better understanding of the patient’s physical, emotional and social needs. Secondly, a study was undertaken in a town where the clinical care of patients in the hospice is shared between the specialist in palliative medicine and the patient’s own family doctor. The family doctors were asked by means of a questionnaire how, after 4 years, they felt this was working, whether they favoured this shared care, whether they would prefer a change of staffing by full-time palliative medicine doctors, whether they would prefer to have total care of inpatients in the hospice without any consultant, whether their knowledge of palliative medicine had increased since the hospice opened, and whether their own practice in their care of other patients in their homes had changed.