Lynn S Frendak1, Scott M Wright1, David Shih Wu1. 1. Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
CONTEXT: Studies have shown that palliative care involvement delivers a multitude of benefits to patients and caregivers. The existing palliative care workforce is inadequate to meet growing demand. Innovative strategies to triage inpatient consults are necessary. OBJECTIVES: To describe the implementation of a new palliative care triage process and to demonstrate its impact on efficiency, teamwork, and patient care. METHODS: A quasi-experimental study design, comparing clinical consult data from a 6-month period before and a 6-month period after implementation of the novel consult triage model. RESULTS: Across the 2 study periods, consult demand increased by 44% while the physician staffing (full time equivalent [FTE]) decreased by 38%. Penetration rate per clinical FTE increased (from 1.9%-2.4%; P = .004). Monthly physician work relative value units (RVUs) per FTE increased from 909 to 1678. Physician encounters with hospitalized patients increased from 284 to 353, and total team visits increased from 596 to 891 (P < .001). Average time to consult decreased by 2.4 hours (P = .54). CONCLUSION: An efficient and streamlined consult triage process had a positive impact on our palliative care team's ability to reach patients. We were able to generate more physician visits and RVUs despite a decrease in physician clinical time, and our penetration rate per physician clinical FTE improved. Our findings highlight the importance of thoughtful and appropriate triage, not to mention teamwork, in helping to augment patient access to palliative care.
CONTEXT: Studies have shown that palliative care involvement delivers a multitude of benefits to patients and caregivers. The existing palliative care workforce is inadequate to meet growing demand. Innovative strategies to triage inpatient consults are necessary. OBJECTIVES: To describe the implementation of a new palliative care triage process and to demonstrate its impact on efficiency, teamwork, and patient care. METHODS: A quasi-experimental study design, comparing clinical consult data from a 6-month period before and a 6-month period after implementation of the novel consult triage model. RESULTS: Across the 2 study periods, consult demand increased by 44% while the physician staffing (full time equivalent [FTE]) decreased by 38%. Penetration rate per clinical FTE increased (from 1.9%-2.4%; P = .004). Monthly physician work relative value units (RVUs) per FTE increased from 909 to 1678. Physician encounters with hospitalized patients increased from 284 to 353, and total team visits increased from 596 to 891 (P < .001). Average time to consult decreased by 2.4 hours (P = .54). CONCLUSION: An efficient and streamlined consult triage process had a positive impact on our palliative care team's ability to reach patients. We were able to generate more physician visits and RVUs despite a decrease in physician clinical time, and our penetration rate per physician clinical FTE improved. Our findings highlight the importance of thoughtful and appropriate triage, not to mention teamwork, in helping to augment patient access to palliative care.
Authors: Arif H Kamal; Devon K Check; Janet Bull; Steven Wolf; Jesse Troy; Greg Samsa; Jonathan M Nicolla; Matthew Harker; Donald H Taylor Journal: J Palliat Med Date: 2020-07-07 Impact factor: 2.947
Authors: P A J Vissers; R H A Verhoeven; G A P Nieuwenhuijzen; M J Westerman; J C H B M Luijten; L Brom; M de Bièvre; J Buijsen; T Rozema; N Haj Mohammad; P van Duijvendijk; E A Kouwenhoven; W J Eshuis; C Rosman; P D Siersema; H W M van Laarhoven Journal: BMC Health Serv Res Date: 2022-04-20 Impact factor: 2.908