Palliative and Supportive Care

Original Articles

Development and implementation of a palliative care consultation tool

Alexei Trouta1, Kenneth L. Kirsha2 and John F. Peppina1a2a3 c1

a1 St. Joseph's Hospital, Continuing Care Hospital, Lexington, Kentucky

a2 The Pain Treatment Center of the Bluegrass, Lexington, Kentucky

a3 The Palliative Care Service, Hospice of the Bluegrass, Lexington, Kentucky

Abstract

Objective: Palliative care services are becoming more commonplace in hospitals and have the potential to reduce hospital costs through length of stay reduction and remediation of symptoms. However, there has been little systematic attempt to identify when a palliative care consultation should be triggered in a hospital, and there is some evidence that these services are under-utilized and not fully understood.

Method: In an initial attempt to address when a consultation might be appropriate, we attempted to pilot test a novel palliative care screening tool to help guide clinician judgment in this regard. A one-page, face-valid instrument was developed using expert opinion.

Results: The sample comprised 33 men (44.6%) and 41 women (55.4%) with an average age of 63.4 years (SD = 13.8) and an average length of stay of 22.7 days (SD = 10.1). The most significant symptom was pain, indicated as moderate-to-severe in 23 patients (31%). This was followed by fatigue (n = 10, 13.5%) and nausea (n = 6, 8.1%). At unit entry, 20 patients (33%) had moderate or severe pain. Upon discharge, this number had been reduced to 12/60 (20%). Chi-Square analysis showed a significant decrease in pain rankings overall (χ2 = 36.3, p < 0.0001). The average total tool score was 7.5 (SD = 3.1). Using an initial threshold of 12 to trigger a palliative care referral, 64 patients (86.5%) would not have received a referral and 10 (13.5%) would have. Of these 10 patients, 2 (20%) did not receive a palliative care consultation while they were hospitalized.

Significance of results: The tool we developed increased consultations over the time period in which it was used, compared with the same time period 1 year prior. Although the threshold developed for triggering referrals seemed artificially high, the implementation of the screening tool did increase referrals.

(Received April 15 2011)

(Accepted August 12 2011)

Correspondence:

c1 Address correspondence and reprint requests to: John F. Peppin, Clinical Research Division, The Pain Treatment Center of the Bluegrass, 2416 Regency Road, Lexington, Kentucky 40503. E-mail: johnpeppin@msn.com