A Survey to Characterize the Palliative Care Needs of All Hospitalized Patients in an Academic Medical Center

• Published in: Journal of pain and symptom management 2024-05, Vol.67 (5), p.e670-e671
• Main Authors: Sharpless, Joanna, MD, Goto, Yuika, MD, Schoenherr, Laura A., MD, O'Riordan, David L., PhD, Pantilat, Steven, MD
• Format: Article
• Language: English
• Subjects: Anesthesia; Pain Medicine
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2024.02.128

Outcomes1. Participants will reflect on the process by which patients are brought to inpatient consult services’ attention and will imagine alternative systems that would help identify PC appropriate patients more promptly and proactively. 2. Learners will examine the ways in which bias and inequity may affect which patients are referred to subspecialty PC in our current system and compare how interdisciplinary team members may perceive patients’ PC needs differently. Key MessageDue to reliance on referrals for consults, the true quantity and quality of palliative care (PC) needs in an inpatient population are unknown. This work describes the process and outcomes of a screen to characterize PC needs in one medical center. It demonstrated significant unmet need and underscores the need for a more proactive and systematic model for PC delivery. IntroductionDue to reliance on referral-based systems for identifying patients, many inpatient palliative care (PC) services are unaware of the true quantity and quality of need at their institutions. ObjectivesScreen all hospitalized patients at a large academic medical center to provide a snapshot of patients’ quantity and quality of PC needs at one moment in time. MethodsA validated EMR-based algorithm for identifying hospitalized patients with serious illness (1) was applied to the adult population at an academic medical center during one week in September 2021. Each patient's primary provider and bedside nurse were asked to respond to a scripted phone survey about their patient's PC needs. Data analysis was performed to compare Results: from the primary provider and nurse surveys, and both were compared against a novel EMR-based screening algorithm to identify PC needs (discussed in a separate abstract). ResultsDuring the survey week, a total of 268 patients were identified as having serious illness, and at least one clinician was surveyed for 224 of these patients (83.6%). Seventeen patients (7.6%) were followed by the inpatient PC consult team at the time. Providers reported that 60 patients (27%) had an unmet PC need. Sixty patients (27%) were reported as having intolerable and/or uncontrolled physical symptoms, with pain being most common. Primary providers reported that 96 patients and/or their caregivers (43%) were experiencing non-physical suffering. Primary providers were concerned that their patient might die during this hospitalization in 16% of cases. ConclusionAccording to a survey of PC needs, over a