Christopher Kearney

Effectiveness of Integration of Palliative Medicine Specialist Services into the Intensive Care Unit of a Community Teaching Hospital

BACKGROUND Collaboration between palliative medicine and the intensive care unit (ICU) represents best practice and offers important benefits. However, achieving effective collaboration between these two specialties can be challenging. OBJECTIVE Assess effectiveness of integrating palliative medicine specialists in the ICU. DESIGN Retrospective chart review. RESULTS Of 201 patients who qualified for palliative consultation using a palliative screening tool, 92 were referred and 109 were not referred for palliative medicine consultation. The number of screening criteria met was similar between the two groups. Palliative medicine consult volume increased significantly compared with preintegration (7.7±3.4 versus 4.4±2.8 consults per month, p=0.04). No significant difference in hospital mortality was found between the referred and unreferred groups (32/92 [35%] versus 26/109 [24%], p=0.09). ICU length of stay was significantly shorter in the referred group (7 versus 11 days, p<0.001). Referred patients were more frequently enrolled in hospice compared with unreferred patients (32/92 [37%] versus 3/109 [3%], p<0.001). ICU physicians referred patients significantly more often for dementia and ventilator withdrawal (13/16, p=0.003; 24/29, p<0.001, respectively) and significantly less often for ICU stay longer than 10 days (21 versus 49, p=0.001). CONCLUSIONS Integrating palliative medicine specialists into intensive care was associated with a significant increase in use of palliative medicine services and a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. The screening tool effectively identified patients at high risk of death. Given the high mortality rate of the unreferred patients, the criteria could be more widely adopted by ICU physicians to consider expanding palliative medicine referrals.

Impact of Standardized Palliative Care Order Set on End-of-Life Care in a Community Teaching Hospital

BACKGROUND We evaluated use of medications and interventions in patients receiving a new standardized palliative care order set (PCOS) compared with patients receiving no palliative care orders and those with an order for comfort measures only (CMO), the largely ineffective method used at our institution before implementation of the order set. METHODS AND RESULTS We conducted a retrospective chart review of all patients who died at our community teaching hospital between November 2006, 8 months after PCOS implementation, and May 2007. Of 106 patients in the study group, 31 (29%) were treated using the PCOS, 6 (6%) received the CMO order, and 69 (65%) did not receive either. Patients in the PCOS group had significantly more orders for every palliative medication (p ≤ 0.05). Opioids and anxiolytics were made available to every patient in the PCOS group. Most PCOS patients received orders for antiemetic, antipsychotic, antisecretion, and laxative medication during the end-of-life period. No CMO patients and few patients in the no palliative care orders group received orders for these medications. The PCOS and CMO group similarly limited nonpalliative interventions, whereas the nonpalliative group had relatively high use of these interventions until death. CONCLUSION The palliative care order set implemented at our community teaching hospital significantly improved adherence to accepted palliative care treatment principles for patients at the end of life.

Precision Pharmacopalliation: A No-Nonsense, Boots-on-the-Ground Approach to Medication Management at the End of Life (P05)

Ignite your leadership potential. Financial DecisionMaking Approaches is designed to equip hospice and palliative medicine physicians with foundational principles in financial management to increase their understanding of institutional or organizational financial reports. This course will provide an introduction to financial concepts and terminology followed by an exploration of cost analysis and resource allocation using sample financial tools and documents, case studies, and scenarios to provide practical relevance for HPM physicians. This preconference program is offered in partnership with the American Association for Physician Leadership (Association) and presented by Association faculty. This session applies to all physician leaders and practice settings looking to enhance their financial management understanding and decision-making for their organization. Primary leadership competencies addressed in this program include financial acumen and resource management. AAHPM Ignite is one of three sessions included in the AAHPM Leadership Forum. AAHPM and the American Association for Physician Leadership have designed a comprehensive leadership training program that offers a variety of learning opportunities and varied environments, including face-to-face didactic instruction and Web-based self-study. You can create your own customized and flexible learning pathway and select content based on your unique leadership development goals and career pathway. Learn more at aahpm.org/career/leadership.

Evaluating the Impact of a Protocol for Terminal Withdrawal of Mechanical Ventilation (S761)

Method. A 13-item anonymous online survey was emailed to 201 pediatric chaplains using the Pediatric Chaplains Network email list. Participants were given one month to respond, with a reminder email sent 3 weeks after the initial email. Result. Seventy respondents participated in the survey for a response rate of 34.8%. Sixty-five percent of respondents stated that their hospital provides grief/bereavement resources following the death of a patient; one-third of respondents stated that they do not offer such resources for patients who died outside the hospital. The majority (86%) of respondents stated that pastoral care was primarily responsible for providing these resources to families. Most (81%) stated that the resources are offered to all family members while others (19%) stated that resources are focused on parents, only. Nearly half (48%) of respondents stated that they believe services offered are insufficient for grieving families. Conclusion. While common themes exist in the bereavement services offered by pediatric hospitals following the death of a child, the breadth and depth of services varied between institutions. Many respondents felt that more should be done to care for grieving families. Implications for Research, Policy, or Practice. More studies are warranted to define the optimal approach to care for families grieving the loss of a child.