Inpatient Referrals Research Articles

P-1893. Evaluation of Infectious Disease Consultation on Outpatient Antimicrobial Therapy (OPAT) Referral Volume and Outcomes

Abstract Background Institutional experience with OPAT is increasingly reported. However, little is known about the referral process across the continuum of care and its impact on OPAT volume and patient outcomes. The purpose of this study is to characterize OPAT referral trends from a multi-service line infectious diseases (ID) group and its impact on end of therapy patient outcomes. Methods This retrospective analysis included adult patients referred to the OPAT program from either of the two system hospitals and seen by any of the five inpatient consult teams or the ambulatory ID clinic between June 2021 and July 2022. Patients were identified via a data extraction from the electronic health record by the institution’s Healthcare Analytics Team or Center for Clinical and Translational Sciences. OPAT patients were identified via the OPAT Electronic Data Capture (REDCap) database. Results A total of 3738 ID consult orders were placed on 2708 patients, dispersed between four consult teams at hospital 1 (Table 1). The OPAT program received 1504 referrals, 1475 (98.1%) inpatient referrals and 29 (1.9%) outpatient. A total of 914 patients were discharged to receive IV antimicrobials, 723 (78.2%) and 191 (32.9%) (p < 0.00001), for standard OPAT (S-OPAT) and modified OPAT (M-OPAT), respectively (Figure 1). End of therapy outcomes were recorded on 798 (87.3%) patients. The Transplant service had the highest percentage of referrals eligible for S-OPAT (90%); however, it also saw the highest 60-day readmission rate (36.2%) (Table 1). There was no statistically significant difference (p = 0.281) in proportion of referrals with end of treatment failure within the ID services at hospital 1. However, therapy extension was more frequent in the Bone and Joint and General ID teams (p < 0.001). Hospital 2 had more patients that were unable to complete their antimicrobial therapy (14.6%) (Table 3). Conclusion Our analysis of patients seen by ID consult services demonstrated a significant portion were ultimately referred for OPAT. Differences in referral rates were noted between service lines, along with differences in 30 and 60-day readmission rates. Overall, end of therapy and clinical outcomes were fairly similar throughout the groups. Disclosures Alisha Clemons, APRN, Gilead Sciences: Honoraria

An Overview of Early Psychosis Care in New Zealand-A Need for Culturally Adapted Service Models.

It has been over 20 years since a review of early psychosis services in New Zealand was completed, and it is unclear if services now meet international best practice. Furthermore, significant disparities in psychosis experiences exist in New Zealand, and it is unclear whether service structure might contribute to such disparities. Given the current restructuring of the health system in New Zealand, now is the optimal time to understand strengths and weaknesses in early psychosis care provision. All early psychosis services in New Zealand (n = 12) were surveyed. Leads from each service completed a survey on the general elements of their service, alongside the First-Episode Psychosis Services Fidelity Scale, which allows comparison with international early psychosis services. Specific services are provided across 11/20 districts, leaving 9 without any dedicated early psychosis care. Service strengths included short wait lists, comprehensive assessments, good provision of case managers, team managers and psychiatrists and good length of care. Relative weaknesses included provision of therapy, limited age ranges, high numbers of inpatient referrals, poor Clozapine usage and limited family participation. There was also a lack of services for people at risk for psychosis. Lack of cultural support staff, models and confidence in meeting cultural needs was also evident. While New Zealand early psychosis services are relatively comparable to international services, certain areas of weakness need to be addressed by decreasing variability in service eligibility, increasing care for those at-risk, wider availability of therapy and family involvement and improved cultural services.

Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data.

Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. This study aims to analyze Saudi Arabia's novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020-2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18-44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. "Unavailable subspecialty" was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Development of specialist palliative care in Dutch hospitals between 2014 and 2020: a repeated survey

BackgroundSpecialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020.MethodsThree cross-sectional surveys of SPCTs in Dutch hospitals were conducted in 2015, 2018 and 2021. Key members of the hospital SPCTs completed questionnaires about the preceding year that included items on hospital and PC program characteristics, hospital-wide integration of specialist PC, and SPCT characteristics (92 hospitals in 2015, 79 in 2018 and 74 in 2021). The analysis included hospitals with an operational SPCT, as determined by providing inpatient PC consultation services. Univariate analyses compared hospitals and SPCTs by year. Significance was determined by p-values < 0.05.ResultsIn 2014, 65% of participating hospitals provided inpatient PC consultations (n = 48). This increased to 92% in 2017 (n = 58) and 98% in 2020 (n = 48). Over the years, participating hospitals showed an increasing level of hospital-wide integration of specialist PC, such as an increased number of dedicated PC outpatient clinics (56% in 2020, compared with 47% in 2017 and 27% in 2014). The annual number of inpatient referrals to SPCTs has increased significantly over the years. The SPCTs have developed significantly in various aspects, including collaboration between primary and hospital care, the availability of services to patients at home and non-clinical activities.ConclusionOver the years, Dutch hospitals have shown growth in hospital-wide integration of specialist PC. Specialist palliative care teams have made significant progress in increasing inpatient consultations, and in improving collaboration between primary and hospital care.

Inpatient referrals to a specialist falls and syncope service: prevalence of STOPPFall FRIDs and review of deprescribing patterns.

Falls are the commonest cause of accidental death in older people and the most frequent reason for their presentation to hospital. The Screening Tool of Older Persons Prescriptions in older adults with high falls risk (STOPPFall) facilitates deprescribing by providing a clear consensus on which medications are considered fall-risk-increasing drugs (FRIDs). This study aimed to determine the prevalence of STOPPFall FRIDs in inpatients referred to a falls and syncope service (FASS). Additionally, we aimed to analyse the impact of a dedicated FASS on deprescribing, both of FRIDs and of non-FRID medications. We conducted a retrospective observational study of all FASS inpatient consultations over a 6-month period (March-August 2021). Patients ≥ 65years old were included. Medications on admission and discharge (following FASS assessment) were reviewed, with FRIDs identified using the STOPPFall deprescribing tool. The prevalence of FRIDs was defined as the proportion of patients who had at least one regular FRID prescribed on admission. In total, 162 patients were included for review: 54.94% were (n = 89) female. The mean age of patients was 79.26years (SD 7.45). STOPPFall FRIDs were prevalent, with 74.07% (120/162) on at least 1 regular FRID. Antidepressants (37.04%, n = 60) and diuretics (27.78%, n = 45) were the most frequently prescribed FRID classes. Of patients with a fracture, the mean number of FRIDs was 2.44 versus 1.56 in those without fracture (p = 0.01). At least one FRID was stopped in 35. 8% (n = 58) of patients. Following FASS review, 28.6% (n = 79) of all admission FRIDs were discontinued. STOPPFall FRIDs are prevalent in patients referred for inpatient FASS consultations. Presentations with acute fracture are associated with higher number of FRIDs on admission. Review by a dedicated hospital falls service leads to a reduction in FRIDs and deprescribing of anti-hypertensive medications.

Inpatient Dermatology referrals: What is the burden? A retrospective review of 14 years of dermatology inpatient referrals.

The lack of dermatological knowledge by non-dermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training. To determine the burden and accuracy of inpatient dermatology referrals. A retrospective cohort study using paper inpatient dermatology referrals from one Health Board between June 2007 and July 2021. Data analysis included timing of referrals; referring speciality; diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses. The average number of referrals per year was 106 (79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals the dermatology team agreed with the differential diagnosis. There was discrepancy in the correctness of diagnosis in all categories, however the paediatricians were most likely to offer a correct differential (44%). In 44% of referrals treatment was commenced by the referring team, most commonly antibiotics. There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues - the need for better dermatological education in medical schools to improve diagnosis accuracy and management of conditions as well as the need to recognise the need for an inpatient dermatology service to review inpatient referrals and advise in diagnosis and management of dermatology cases on the wards, and to protect the service from being uncoupled from the main hospital.

Impact of a Criteria-Based Inpatient Palliative Oncology Consultation Model on End-of-Life Outcomes

Early, integrated palliative care (PC) improves outcomes in advanced cancer; however, inpatient PC referrals still exceed outpatient referrals nationwide. Recognizing need for enhanced integration, our cancer center implemented a criteria-based PC consultation model in inpatient oncology. To compare decedent outcomes pre- and postimplementation of a new criteria-based PC consultation model in inpatient oncology. We implemented an embedded, interdisciplinary "Palliative Oncology" consult team on the oncology floor. Admitted patients were screened for advanced/metastatic solid cancer or moderate/severe symptoms. The oncology team received prompting regarding eligible patients; PC referral remained at their discretion. We compared outcomes between patients who died pre- (10/1/2019-6/30/2020) and postimplementation (7/1/2020-6/30/2022) by t-test (continuous variables) and chi-square test (categorical variables). Of 820 decedents, 186 died preintervention and 634 died postintervention. Postintervention, more decedents saw inpatient PC (59%-72%, P < 0.001) and outpatient PC (23%-34%, P < 0.01), and had earlier first PC visit before death (76-159 days, P < 0.001). Postintervention, fewer decedents had hospitalizations (71%-57%, P < 0.001) and intensive care encounters (25%-17%, P < 0.01) within last 30 days of life. Hospice length-of-stay increased (22-36 days, P < 0.01). There were trends toward fewer emergency room visits within last 30 days of life (51%-42%, P = 0.02), less systemic cancer therapy within last 14 days of life (9%-5%, P = 0.03), and more deaths at home (41%-50%, P = 0.03). Embedded, criteria-based PC consultation in inpatient oncology was associated with earlier PC involvement, longer hospice LOS, and reduced EOL care intensity.

Assessment of Reason for Exam Imaging Reporting and Data System (RI-RADS) in inpatient diagnostic imaging referrals

ObjectivesTo test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS.MethodsA single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests.ResultsWe included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade.ConclusionThe majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings.Critical relevant statementThe implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement.Key PointsRI-RADS aims to grade the completeness of radiology requests.Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability.Most radiology requests were inadequate and RI-RADS could classify them in clinical practice.Graphical

Retrospective Investigation of the Utility of Potassium Hydroxide Smear in the Diagnosis and Management of Cutaneous Fungal Infections by Dermatologists.

Superficial cutaneous fungal infections are common dermatologic conditions. A significant proportion do not present with typical clinical findings. However, the 10% potassium hydroxide (KOH) smear, a simple bedside test, is often underused when diagnosing cutaneous fungal infections. We aimed to evaluate whether KOH smear results altered dermatologists' diagnosis and management, and the factors that influenced its ability to detect cutaneous fungal infections. A total of 373 patients with suspected cutaneous fungal infection were identified retrospectively from the dermatology database of inpatient referrals in a Singapore tertiary hospital between 1 January 2017 and 30 June 2020. The dermatologists' eventual diagnoses, based on their assessment until 2 months post-discharge to allow consideration of KOH smear results and response to treatment, were taken as a gold standard. Statistical analyses evaluated for changes between initial and eventual diagnoses and management relative to the KOH smear. Use of topical steroids, topical and/or systemic antifungals before skin sampling, and whether sampling was done by dermatologically-trained personnel, were assessed for association with KOH smear positivity in eventually diagnosed cases. The percentage of uncertain diagnoses was reduced, and the use of topical antifungal as the sole treatment significantly changed after the KOH smear result was available. The adjusted odds ratio of a positive KOH smear in eventually diagnosed cases was 0.19 when systemic antifungals were used before skin sampling, and 3.03 if sampling was performed by a dermatologically-trained person. Limitations of our study include dependence on retrospective medical records which may result in misclassification bias and the limited generalisability of our results to patients managed by non-dermatologists. KOH smear is a useful adjunct in diagnosing and managing cutaneous fungal infections. Clinicians should consider the presence of confounders affecting KOH smears when making an overall clinical diagnosis. Focused training of personnel on skin sample collection may improve the detection rate of KOH smear.

Development of a novel cancer diagnostic center to facilitate care coordination for patients with new or suspected diagnoses of cancer.

81 Background: Navigating a cancer diagnosis is a multifaceted challenge, characterized by intricate care coordination that creates potential for workup and treatment delays, lapses in care, and potentially negatively affecting clinical outcomes. We have developed a novel physician and advanced practitioner-led cancer diagnostic program (CDP) to help navigate patients with a suspected cancer through the diagnostic and staging workup, discussion of results, and linkage to oncologic care. Patients are referred to the CDP, an administrative intake coordinator creates a medical chart, verifies insurance, gathers records, and schedules appointments. An intake nurse reaches out within 24 hours to obtain clinical information and review of systems. Patients are offered an in-person or video visit with the advanced practitioner for history and physical, labs, and further coordination of testing. Here, we aim to describe the demographic and clinical patterns of referral and clinical outcomes of patients who were referred to a CDP over one calendar year. Methods: We retrospectively analyzed 154 patients with a new cancer diagnosis to have at least 1 encounter at the Johns Hopkins CDP between January 1, 2022, and December 31, 2022. Data were retrospectively collected from medical records and stored within Johns Hopkins REDCap. Descriptive analyses were used to describe the data. Results: Among the 154 total patients included in this analysis, 65.6% were White, 24.7% were Black, 3.2% were Asian, and 1.9% were of Hispanic, Latino, or Spanish origin. Insurance coverage was most frequently (46.8%), Medicare (40.3%), and Medicaid (8.4%). Referral distribution shows 50 inpatient and 104 outpatient referrals. Primary cancer diagnoses were most often gastrointestinal (39.6%), upper airway and lung (26.6%), and genitourinary (9.1%). Conclusions: The Johns Hopkins CDP exemplifies the potential for dedicated diagnostic and treatment initiation programs to improve oncologic care, particularly for vulnerable populations. The center facilitates expedited diagnostic resolution, to increased ease of workup for patients and providers, and potentially improve clinical outcomes such as linkage to care and time to treatment. Accepting referrals from inpatient and outpatient settings captures a broad patient pool, including those who may otherwise experience lapses in care owing to complex care navigation needs. In conclusion, we describe a novel care delivery model to potentially optimize healthcare delivery in oncologic care. Inpatient Referral Outpatient Referral Percent minority populations 34% 23.1% Stage 4 at diagnosis 74% 52.9% Patients initiating treatment with curative intent 42.3% 30% Median length of hospitalization 7 days N/A Median time from pathology results to discharge -2.5 days N/A Median time from pathology results to treatment initiation 20 days 16.5 days

Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department

Abstract Background This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED). Methods A retrospective chart review was conducted on all patients (&amp;gt;65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults &amp;gt;75) for those with a PHF was also analysed. Results A total of 53 older adults (&amp;gt;65) were identified within the study period with a PHF while 43 patients (&amp;lt;65) were identified. In the &amp;gt;65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the &amp;gt;65 group required admission to hospital (N=24) (P&amp;lt;0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (&amp;gt;75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (&amp;gt;75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package. Conclusion PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.

Abstract B132: Access to palliative care for individuals with cancer experiencing homelessness

Abstract Introduction Persons experiencing homelessness (PEH) face significant disparities in health outcomes and access to healthcare, including cancer-related and end-of-life care. PEH are less likely to receive age-appropriate cancer screening, more likely to be diagnosed with cancer at later stages, and more likely to die secondary to cancer compared to the general population. Qualitative research has demonstrated that PEH and the providers who care for them perceive gaps in access to palliative care, largely due to a lack of palliative care programs that cater to the specific needs of PEH. However, less is known about how medical providers’ referral patterns affect access to care. Providers may be less likely to refer PEH to palliative care services because of these known gaps in access, exacerbating existing disparities. The purpose of this study was to quantify the rates of palliative care referrals and outpatient palliative care visits along with time to initial palliative care referral and ambulatory palliative care visit. We hypothesized that PEH would be referred to palliative care at lower rates and have longer intervals to palliative care follow-up as compared to their housed counterparts. Methods A retrospective analysis was performed on patients with cancer admitted to an academic center’s medical oncology service between July 2022 and June 2023. Patients were stratified into two groups based on their housing status: housed and PEH. A comparative quantitative analysis was conducted between these groups. Results 1166 patients with cancer were admitted to the medical oncology service during the one-year study period. The mean age of the cohort was 61.0 years and 46.7% were female. Seventeen (1.4%) PEH and 1149 (98.6%) patients who were housed were identified. Among PEH, five (29.4%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Among patients who were housed, 362 (31.5%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Two (11.8%) PEH attended an ambulatory palliative care appointment compared to 183 (15.9%) patients who were housed. The mean number of days to first palliative care or hospice referral/consult was 25.5 in PEH and 43.9 in patients who were housed. The mean number of days to first ambulatory palliative care visit was 131 in PEH and 83.7 in patients who were housed. Conclusion The frequency of inpatient and ambulatory palliative care referrals was comparable between the two groups, suggesting that PEH are appropriately referred to palliative care. However, PEH had longer intervals from cancer diagnosis to first outpatient palliative care visit, suggesting that additional supports may be needed to ensure PEH can access outpatient follow-up. While this quantitative study is underpowered to detect statistically significant differences, it highlights a potential area for further study to develop interventions to better support PEH to achieve timely follow-up with ambulatory palliative care and hospice services after referral. Citation Format: Brandon A. Bellen, Katarina Leyba, Amanda V. Johnson, Eric Grimm, Erin Bredenberg. Access to palliative care for individuals with cancer experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B132.

Bringing Value at the Physical and Mental Health Interface: A Retrospective Record-based Research of Diagnostic Concordance between Physicians/Surgeons and Psychiatrists

Abstract Introduction: Consultation-liaison psychiatry (CLP) serves as a vital bridge between psychiatric and medical specialties, offering expert opinions and educational support. Despite high psychiatric comorbidities, referral rates in most parts of the world remain low. Poor psychiatric awareness, stemming from inadequate undergraduate psychiatric training, may contribute to the difficulty in detecting these symptoms. Studying concordance between psychiatric diagnoses made by referring doctors and psychiatrists can shed light on this area. Aims: This study aims to explore the concordance between diagnoses made by physicians and psychiatrists. Settings and Design: A 3-year retrospective record-based research was conducted at a tertiary care center. Methods: The study focused on in-patient referrals to the CLP unit. Data from 2917 referral calls included demographic profiles, referral reasons, and diagnoses. The Concordance was assessed using kappa statistics, with interpretation based on Landis and Koch’s criteria. Results: Delirium emerged as the most frequent psychiatric diagnosis, followed by depressive disorders, alcohol dependence, adjustment disorder, and opioid dependence. Referral patterns showed limited use of specific psychiatric terms by physicians (5.9%). Concordance varied across diagnoses, with substance use and intentional self-harm displaying substantial agreement, while delirium and depression had lower concordance. Conclusion: The study highlights the prevalence of delirium in CLP referrals and emphasizes the need for collaboration between CLPs and physicians. It also reveals a limited use of specific psychiatric diagnoses by referring doctors, suggesting potential gaps in psychiatric awareness. The findings underscore the importance of targeted educational interventions and increased collaboration to enhance diagnostic accuracy and patient outcomes.

Palliative Care Utilization Among Hospitalized Patients With Hepatocellular Cancer: A Nationwide Study in the Pandemic Era (2019-2021).

Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.

Impact of Palliative Care Referral on End-of-Life Outcomes for Patients With Hematologic Malignancy.

Compared to patients with solid malignancies, less is known about the role of palliative care in patients with hematologic malignancies, leading to underutilization of palliative care. Evaluate the timing and impact of palliative care referrals on end-of-life outcomes over a 5-year period with intent to improve the utilization of palliative care in patients with advanced hematologic malignancies. A retrospective cohort of patients from an urban, NCI-designated comprehensive cancer center, aged 18years and older with a diagnosis of an advanced hematologic malignancy were separated into groups of early, late, very late, or no specialty palliative care. Logistic regression models were constructed to examine variables associated with timing of palliative care referral. Groups were compared using the Kruskal Wallis test and Dunn's test with a Bonferroni correction method. 222 patients with advanced hematologic malignancies who died between July 1, 20218 and June 30, 2023 were included. 50 (23%), 41 (18%), and 51 (23%) patients received an early, late, and very late palliative care referral, respectively and 80 (36%) patients did not receive a palliative care referral. There was a significantly high completion of ACP documentation among the palliative care cohorts. There was no significant difference among all cohorts in end-of-life outcomes in the last 14 or 30days of life. ACP documentation improved with palliative care, however, end-of-life outcomes did not. These results are likely due to the majority of late, inpatient palliative care referrals. Future studies with targeted interventions are needed to improve these outcomes.

341 Improving Plastic Surgery Inpatient Referrals at a Major Trauma Centre: A Closed Loop Audit

341 Improving Plastic Surgery Inpatient Referrals at a Major Trauma Centre: A Closed Loop Audit

Addressing Perinatal Substance Use: A Triad Approach Led by the Colorado Perinatal Care Quality Collaborative.

Unintentional overdose is a leading driver of maternal death in Colorado. The high volume of maternal deaths from preventable causes lends questions to failures in our clinical and community-based care for pregnant and postpartum people. The Colorado Maternal Mortality Review Committee identified 3 main contributors including stigma in the community and health care system, fragmentation of the health care system, and the need for more clinician training. The Colorado Perinatal Care Quality Collaborative led a 3-pronged intervention to address these challenges and improve perinatal care. The first intervention, the Colorado Alliance for Innovation on Maternal Health Substance Use Disorder quality improvement initiative, partnered with birthing hospitals statewide to institute universal screening and timely referral for individuals at risk of substance use disorder (SUD) and perinatal mood and anxiety disorders. The second intervention, the Improve Perinatal Access, Coordination, and Treatment for Behavioral Health initiative, established a perinatal support network within communities. This program assists individuals with SUD, perinatal mood and anxiety disorders, or social needs to navigate the perinatal period. The third intervention, the Colorado Maternal Overdose Matters Plus program, has enhanced in-hospital access to pharmacotherapy for pregnant and postpartum individuals with SUD through training and technical support. These collaborative initiatives aim to minimize barriers to care by integrating inpatient screening, treatment referrals, pharmacotherapy access, and community care support to mitigate maternal mortality in Colorado.

Assessing the reach and safety of an innovative urgent care service tailored to older adults.

Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician-led treatment pathways consisting of a ward-based treatment centre and an in-home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians.

Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study

ObjectivesIn the first year of the COVID-19 pandemic, health systems implemented programmes to manage outpatients with COVID-19. The goal was to expedite patients’ referral to acute care and prevent overcrowding...

The role of an integrated referral program for patients with liver disease: A network between hub and spoke centers.

Access to Liver transplantation (LT) can be affected by several barriers, resulting in delayed referral and increased risk of mortality due to complications of the underlying liver disease. To assess the clinical characteristics and outcomes of patients with acute or chronic liver disease referred using an integrated referral program. An integrated referral program was developed in 1 October 2017 based on email addresses and a 24/7 telephone availability. All consecutive adult patients with liver disease referred for the first time using this referral program were prospectively collected until 1 October 2021. Characteristics and outcomes of inpatients were compared with a historical cohort of patients referred without using the integrated referral program (1 October 2015-1 October 2017). Patients were further divided according to pre- and post-Covid-19 pandemic. Two hundred eighty-one referred patients were considered. End stage liver disease was the most common underlying condition (79.3%), 50.5% of patients were referred as inpatients and 74.7% were referred for LT evaluation. When inpatient referrals (n=142) were compared with the historical cohort (n=86), a significant increase in acute liver injury due to drugs/herbals and supplements was seen (p=0.01) as well as an increase in End stage liver disease due to alcohol-related liver disease and NASH, although not statistically significant. A significant increase in referrals for evaluation for Trans-jugular intrahepatic portosystemic shunt placement was seen over time (5.6% vs. 1%; p=0.01) as well as for LT evaluation (84.5% vs. 81%; p=0.01). Transplant-free survival was similar between the study and control groups (p=0.3). The Covid-19 pandemic did not affect trends of referrals and patient survival. The development of an integrated referral program for patients with liver disease can represent the first step to standardize already existing referral networks between hub and spoke centers. Future studies should focus on the timing of referral according to different etiologies to optimize treatment options and outcomes.