BACKGROUND/ OBJECTIVE: Increased attention has been directed at the intersection of emergency and palliative medicine, since decisions made in the emergency department (ED) often determine the trajectory of subsequent medical treatments. Specifically, we examined whether inpatient admissions after palliative care (PC) consultation initiated in the ED were associated with decreased length of stay (LOS), compared with those in which consultations were initiated after hospital admission. METHODS: Education and training on PC and the consultation service were provided to ED physicians and nurses. The PC service evaluated patients in the ED during weekdays and provided telephone consultation nights and weekends with postadmission follow-up. We compared the outcomes of these patients with those whose PC needs were identified and addressed through consultation postadmission. PC consultation data between January 2006 and December 2010 were retrospectively collected from the administrative records system and analyzed using propensity scores within multivariate regression. RESULTS: Included in the analysis were 1435 PC consultations, 50 of which were initiated in the ED across the 4-year study period. Propensity scores were calculated using patient-level characteristics, including All Patient Refined Diagnostic Related Group (APRDRG) risk of mortality (ROM) and severity of illness (SOI), age, gender, readmission status, facility, and insurance type. Regression results showed that consultation in the ED was associated with a significantly shorter LOS by 3.6 days (p<0.01). CONCLUSIONS: Early initiation of PC consultation in the ED was associated with a significantly shorter LOS for patients admitted to the hospital, indicating that the patient- and family-centered benefits of PC are complemented by reduced inpatient utilization.
BACKGROUND/ OBJECTIVE: Increased attention has been directed at the intersection of emergency and palliative medicine, since decisions made in the emergency department (ED) often determine the trajectory of subsequent medical treatments. Specifically, we examined whether inpatient admissions after palliative care (PC) consultation initiated in the ED were associated with decreased length of stay (LOS), compared with those in which consultations were initiated after hospital admission. METHODS: Education and training on PC and the consultation service were provided to ED physicians and nurses. The PC service evaluated patients in the ED during weekdays and provided telephone consultation nights and weekends with postadmission follow-up. We compared the outcomes of these patients with those whose PC needs were identified and addressed through consultation postadmission. PC consultation data between January 2006 and December 2010 were retrospectively collected from the administrative records system and analyzed using propensity scores within multivariate regression. RESULTS: Included in the analysis were 1435 PC consultations, 50 of which were initiated in the ED across the 4-year study period. Propensity scores were calculated using patient-level characteristics, including All Patient Refined Diagnostic Related Group (APRDRG) risk of mortality (ROM) and severity of illness (SOI), age, gender, readmission status, facility, and insurance type. Regression results showed that consultation in the ED was associated with a significantly shorter LOS by 3.6 days (p<0.01). CONCLUSIONS: Early initiation of PC consultation in the ED was associated with a significantly shorter LOS for patients admitted to the hospital, indicating that the patient- and family-centered benefits of PC are complemented by reduced inpatient utilization.
Authors: Nita Khandelwal; Ann C Long; Robert Y Lee; Cara L McDermott; Ruth A Engelberg; J Randall Curtis Journal: Lancet Respir Med Date: 2019-05-20 Impact factor: 30.700
Authors: Corita R Grudzen; Abigail M Schmucker; Deborah J Shim; Aminat Ibikunle; Jeanne Cho; Frank R Chung; Susan E Cohen Journal: J Palliat Med Date: 2019-09 Impact factor: 2.947
Authors: Gulcan Bagcivan; Marie Bakitas; Jackie Palmore; Elizabeth Kvale; Ashley C Nichols; Stephen L Howell; J Nicholas Dionne-Odom; Gisella A Mancarella; Oladele Osisami; Jennifer Hicks; Chao-Hui Sylvia Huang; Rodney Tucker Journal: J Palliat Med Date: 2019-03-11 Impact factor: 2.947
Authors: Jessica Ma; Stephen Chi; Benjamin Buettner; Katherine Pollard; Monica Muir; Charu Kolekar; Noor Al-Hammadi; Ling Chen; Marin Kollef; Maria Dans Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598