Teresa Albanese

Optimizing the Success of a Palliative Care Consult Service: How to Average Over 110 Consults Per Month

The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. The PCCS is a mobile interdisciplinary team established to provide accessible, comprehensive end-of-life care and symptom management to patients with advanced illness within the health care system. Critical to its success, the team developed and maintained a database to document growth and ensure continuous quality improvement. A description of this database is provided, along with current performance outcomes. The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.

Patients’ knowledge and perspectives on wet age-related macular degeneration and its treatment

Summary: There have been no studies examining the level of understanding age-related macular degeneration (ARMD) patients have about their disease, or their perceptions about intraocular injections as treatment. In this study, patient knowledge about ARMD risk factors was low but patients appeared more optimistic than fearful when confronted with intraocular antivascular endothelial growth factor (anti-VEGF) injections as treatment. Purpose: In recent years there has been an increase in our understanding of wet ARMD, and a dramatic shift in the treatment paradigm. However, to our knowledge, no studies have examined how much ARMD patients understand their disease, or how they feel about receiving intraocular injections as treatment. The primary objectives of this study are to identify areas in which ARMD patients may be uninformed about their disease, and to recognize specific fears or expectations that patients may have regarding treatment with intraocular anti-VEGF injections. Design: Prospective, survey-based study. Methods: This is a prospective survey-based study. An anonymous 32-item questionnaire was compiled and distributed to patients with wet ARMD who underwent at least one intraocular anti-VEGF injection. Eighty-three patients from a retina practice in a suburban setting completed the questionnaire that gauged both their knowledge of ARMD and their perspectives on its treatment. Data was analyzed using chi-square testing. Results: Seventy-eight percent of patients received most of their knowledge of ARMD from their physician. Eighty-nine percent of patients prefer to receive more information on ARMD, if needed, directly from their physician. Only 21%, 48%, 37%, 48%, and 36%, respectively, correctly identified how diet, special vitamins, high blood pressure, family history, and smoking can affect ARMD. Sixty percent felt somewhat afraid or very afraid about getting their first intraocular injection but this did not correlate with pain or discomfort during treatment (P = 0.075, P = 0.117). Eighty-nine percent were very satisfied and 11% were somewhat satisfied with the explanation their physician gave them about the injections. Eighty percent reported feeling hopeful (significantly more than any other emotion) when they were first told they needed an intraocular injection for treatment of their disease. Conclusions: Knowledge of risk factors and risk factor modification among patients with ARMD is low. Since the vast majority of ARMD patients prefer to receive information directly from their physician, patient education is crucial in improving risk factor modification and alleviating fears of treatment. With the advent of anti-VEGF agents, patients appear more hopeful of regaining vision than they are fearful of treatment with intraocular injections.

The Impact of a Palliative Care Consult Service on Patient Code Status and Discharge Outcomes (702)

Objectives 1. Discuss Palliative Care Consult Service functions with regard to Advance Directives and provider documentation of code status. 2. Describe the transition from full code to full medical management to comfort care only. 3. Explain the relationship between code status, discharge planning, and outcome. I. Background. Hospital inpatient Palliative Care Consult Services (PCCS) assist patients and families in establishing goals of care; arranging for continued medical care; and discharge consistent with those goals. Outcomes commonly include advance directives or DNR orders. II. Research Objectives. This study examines the impact of palliative care consults on changes in patient code status and discharge outcomes. III. Methods. Data were obtained from the PCCS administrative database on a sample of patients for whom code status change was documented. Descriptive statistics were conducted on reasons for the consult, code status changes, days between consult and code status change, and discharge outcomes. IV. Results. Code status changed to Comfort Care Only (CCO) for 539 patients; 46% from DNR CCA (a designation specific to Ohio, which requires full medical management until cardiorespiratory arrest at which time CCO takes effect) and 54% from full code. End-of-life issues were the reason for 75% of consults. Discharge status for 71% was death and for 18% hospice care. Code status changed on average 2.2 days after consult, 51% occurring on the same day. There were 435 patients who became DNR CCA; 428 (98%) were full code when the consult was requested. End-of-life issues was the reason for 67% of consults and establish goals of care for 16%. Discharge status for 47% was death and for 22% hospice care. Code status changed on average 1.4 days after consult, 62% occurring on the same day. V. Conclusion. The PCCS facilitates establishing goals of care and initiates appropriate care for patients with advanced disease. Many PCCS requests involve helping dying patients and families with end-of-life issues, resulting in code status changes and/or hospice enrollment. VI. Implications for Research, Policy, or Practice. A hospital inpatient PCCS supports patients and families facing end-of-life decisions and care, helping assure that patients receive medically appropriate care that is consistent with their goals.