Emmett A Kistler1, Erin Stevens2, Erin Scott2, Lisa L Philpotts3, Joseph A Greer4, Jeffrey L Greenwald5. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: ekistler1@mgh.harvard.edu. 2. Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. 3. Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA. 4. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. 5. Department of Medicine, Core Educator Faculty, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
CONTEXT: Palliative care improves the quality of care and may reduce utilization, but delays or the absences of such services are common and costly in inpatient and emergency department settings. Triggered palliative care consults (PCCs) offer one way to identify patients who would benefit from palliative care and to connect them with services early in their course. Consensus reports recommend use of triggers to identify patients for PCC, but no standards exist to guide trigger design or implementation. OBJECTIVES: To conduct a systematic review of published trigger tools for PCC. METHODS: Studies included quality improvement and prospective analyses of triggers for PCC for adults in the emergency department and inpatient settings since 2008. Paired reviewers evaluated the studies for inclusion criteria and extracted data related to study demographics, trigger processes, trigger criteria, and study bias. RESULTS: The search yielded 5773 citations. Twenty studies were included for final analysis with more than 17,000 patients represented. Trigger processes and composition were heterogeneous, although frequently used categories, such as cancer, dementia, and chronic comorbidities, were identified. Three-quarters of the studies were deemed to have moderate or high risk of bias. CONCLUSION: We present a range of trigger tools spanning different hospital settings and patient populations. Common themes in implementation and content arose, but the limitations of these studies are notable, and further rigorous randomized comparisons are needed to generate standards of care. In addition, future studies should focus on developing triggers that identify patients requiring primary-level vs. specialty-level palliative care.
CONTEXT: Palliative care improves the quality of care and may reduce utilization, but delays or the absences of such services are common and costly in inpatient and emergency department settings. Triggered palliative care consults (PCCs) offer one way to identify patients who would benefit from palliative care and to connect them with services early in their course. Consensus reports recommend use of triggers to identify patients for PCC, but no standards exist to guide trigger design or implementation. OBJECTIVES: To conduct a systematic review of published trigger tools for PCC. METHODS: Studies included quality improvement and prospective analyses of triggers for PCC for adults in the emergency department and inpatient settings since 2008. Paired reviewers evaluated the studies for inclusion criteria and extracted data related to study demographics, trigger processes, trigger criteria, and study bias. RESULTS: The search yielded 5773 citations. Twenty studies were included for final analysis with more than 17,000 patients represented. Trigger processes and composition were heterogeneous, although frequently used categories, such as cancer, dementia, and chronic comorbidities, were identified. Three-quarters of the studies were deemed to have moderate or high risk of bias. CONCLUSION: We present a range of trigger tools spanning different hospital settings and patient populations. Common themes in implementation and content arose, but the limitations of these studies are notable, and further rigorous randomized comparisons are needed to generate standards of care. In addition, future studies should focus on developing triggers that identify patients requiring primary-level vs. specialty-level palliative care.
Authors: Joan G Carpenter; Laura C Hanson; Nancy Hodgson; Andrew Murray; Daniel S Hippe; Nayak L Polissar; Mary Ersek Journal: Contemp Clin Trials Commun Date: 2021-07-26
Authors: Frederica Montanari Lourençato; Carlos Henrique Miranda; Marcos de Carvalho Borges; Antonio Pazin-Filho Journal: Int J Emerg Med Date: 2022-09-16
Authors: Catriona R Mayland; Qiaoling Marilyn Ho; Hannah C Doughty; Simon N Rogers; Prithvi Peddinti; Praytush Chada; Stephen Mason; Matthew Cooper; Paola Dey Journal: Palliat Med Date: 2020-10-21 Impact factor: 4.762
Authors: Christopher E Cox; Deepshikha Charan Ashana; Krista L Haines; David Casarett; Maren K Olsen; Alice Parish; Yasmin Ali O'Keefe; Mashael Al-Hegelan; Robert W Harrison; Colleen Naglee; Jason N Katz; Allie Frear; Elias H Pratt; Jessie Gu; Isaretta L Riley; Shirley Otis-Green; Kimberly S Johnson; Sharron L Docherty Journal: JAMA Netw Open Date: 2022-01-04