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Impact of a Consult Cap for a Busy Inpatient Palliative Care Program (S773)
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Scientific Poster Abstracts
Vol. 53 No. 2 February 2017
Research Objectives. The purpose of this study is to
Original Research Background. The ability of many
identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. Methods. We retrospectively identified 100 patients using a single electronic medical record admitted with diagnoses of cancer and pain to a single academic center from July 2013 to July 2014. Patients were grouped into either ‘‘young adult’’, defined in the literature as ages 18-39 years (N¼26), or ‘‘older adult’’ cohorts (N¼74). Basic demographic data, type of cancer, readmissions within 30 days for pain, and information regarding pain regimens were collected. Fisher’s exact tests, and Wilcoxon rank-sum tests were used to identify differences between young and older adults. Results. The majority of patients in both groups were admitted for abdominal pain but the cancer type varied. Gastrointestinal (not colorectal) cancer was most common in older adults compared to hematologic malignancy or sarcoma in YAs. The median length of hospitalization was 5.0 days for both YAs and older adults. Younger adults received a median daily oral morphine equivalent (OME) of 290 mg compared to 72 mg for older adults (p¼0.034). Younger adults were more likely to use a PCA compared to older adults (54% vs. 28%; p¼0.030). Palliative care consultation rates were similar between YAs and older adults (54% vs. 50%; p¼0.82), as were readmissions for pain (3% vs. 11%; p¼0.44). Conclusion. This study found that in YAs admitted with cancer-related pain, there is a higher median OME per 24-hour requirement, along with increased PCA use.
hospital-based palliative care programs to provide highquality care in a sustainable fashion is now paradoxically threatened by their own success. Approximately 10% of such programs have responded by instituting caps on consults, but the effects are unknown. Methods. We identified all palliative care inpatient consults requested from July 1, 2014 to April 30, 2016 at a large academic hospital. We describe the implementation of a hospital-wide daily cap on new consults on May 1, 2015, and compare the volume, characteristics, and timing of consults in the year before and year after the cap.
Implications for research, policy or practice. Future research is needed to identify tailored treatment regimens for YAs with cancer-related pain.
Results. The hospital-wide cap on new palliative care consults was typically set at 8 per day and varied based on available staffing and census. Consults requested after the cap were prioritized the following day. Mean monthly consult requests increased from 157.7 (range 126-196) in the year before to 173.7 (range 155-209) in the year after the cap (p<0.001), while the proportion actually seen decreased from 96.4% to 88.6% (p<0.001). There was no difference in mean pre-consult length of stay (8.4 days [SD 14.8] vs. 8.6 days [SD 14.3], p¼0.75), the proportion of patients transitioned from aggressive to comfort care (38% vs. 35%, p¼0.08), or the number of patients discharged to hospice (287 (25.4%) vs. 263 (24.4%), p¼0.59). Following the cap, reduced proportions of consults originated from the Oncology and ICU services, and an increased proportion from General Medicine, but not all changes were statistically significant. Conclusion. Implementation of a daily cap on new palliative care consults did not reduce consultative demand, increase the time to consultation, or change the rates of hospice referrals or transitions in goals of care.
Implications for research, policy or practice.
Impact of a Consult Cap for a Busy Inpatient Palliative Care Program (S773) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Mary Moyer, BSN RN, Hospital of the University of Pennsylvania, Glenside, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Scott Halpern, MD PhD, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania, Philadelphia, PA Objectives Describe implementation of an inpatient consult cap at a large academic hospital. Examine the impact of implementing a daily consult cap on a palliative care program.
Future research is needed to examine the impact of capping consults on patient- and family-centered outcomes, including among those whose consults were deferred.
Excess Consult Volume for Hospital-Based Palliative Care Teams in the U.S. (S774) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Jacqueline McMahon, MSW, University of Pennsylvania, Philadelphia, PA. Kuldeep Yadav, BA, FIELDS Program, University of Pennsylvania, Philadelphia, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Elizabeth Cooney, MPH, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania,
Scientific Poster Abstracts
Vol. 53 No. 2 February 2017
Research Objectives. The purpose of this study is to
Original Research Background. The ability of many
identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. Methods. We retrospectively identified 100 patients using a single electronic medical record admitted with diagnoses of cancer and pain to a single academic center from July 2013 to July 2014. Patients were grouped into either ‘‘young adult’’, defined in the literature as ages 18-39 years (N¼26), or ‘‘older adult’’ cohorts (N¼74). Basic demographic data, type of cancer, readmissions within 30 days for pain, and information regarding pain regimens were collected. Fisher’s exact tests, and Wilcoxon rank-sum tests were used to identify differences between young and older adults. Results. The majority of patients in both groups were admitted for abdominal pain but the cancer type varied. Gastrointestinal (not colorectal) cancer was most common in older adults compared to hematologic malignancy or sarcoma in YAs. The median length of hospitalization was 5.0 days for both YAs and older adults. Younger adults received a median daily oral morphine equivalent (OME) of 290 mg compared to 72 mg for older adults (p¼0.034). Younger adults were more likely to use a PCA compared to older adults (54% vs. 28%; p¼0.030). Palliative care consultation rates were similar between YAs and older adults (54% vs. 50%; p¼0.82), as were readmissions for pain (3% vs. 11%; p¼0.44). Conclusion. This study found that in YAs admitted with cancer-related pain, there is a higher median OME per 24-hour requirement, along with increased PCA use.
hospital-based palliative care programs to provide highquality care in a sustainable fashion is now paradoxically threatened by their own success. Approximately 10% of such programs have responded by instituting caps on consults, but the effects are unknown. Methods. We identified all palliative care inpatient consults requested from July 1, 2014 to April 30, 2016 at a large academic hospital. We describe the implementation of a hospital-wide daily cap on new consults on May 1, 2015, and compare the volume, characteristics, and timing of consults in the year before and year after the cap.
Implications for research, policy or practice. Future research is needed to identify tailored treatment regimens for YAs with cancer-related pain.
Results. The hospital-wide cap on new palliative care consults was typically set at 8 per day and varied based on available staffing and census. Consults requested after the cap were prioritized the following day. Mean monthly consult requests increased from 157.7 (range 126-196) in the year before to 173.7 (range 155-209) in the year after the cap (p<0.001), while the proportion actually seen decreased from 96.4% to 88.6% (p<0.001). There was no difference in mean pre-consult length of stay (8.4 days [SD 14.8] vs. 8.6 days [SD 14.3], p¼0.75), the proportion of patients transitioned from aggressive to comfort care (38% vs. 35%, p¼0.08), or the number of patients discharged to hospice (287 (25.4%) vs. 263 (24.4%), p¼0.59). Following the cap, reduced proportions of consults originated from the Oncology and ICU services, and an increased proportion from General Medicine, but not all changes were statistically significant. Conclusion. Implementation of a daily cap on new palliative care consults did not reduce consultative demand, increase the time to consultation, or change the rates of hospice referrals or transitions in goals of care.
Implications for research, policy or practice.
Impact of a Consult Cap for a Busy Inpatient Palliative Care Program (S773) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Mary Moyer, BSN RN, Hospital of the University of Pennsylvania, Glenside, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Scott Halpern, MD PhD, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania, Philadelphia, PA Objectives Describe implementation of an inpatient consult cap at a large academic hospital. Examine the impact of implementing a daily consult cap on a palliative care program.
Future research is needed to examine the impact of capping consults on patient- and family-centered outcomes, including among those whose consults were deferred.
Excess Consult Volume for Hospital-Based Palliative Care Teams in the U.S. (S774) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Jacqueline McMahon, MSW, University of Pennsylvania, Philadelphia, PA. Kuldeep Yadav, BA, FIELDS Program, University of Pennsylvania, Philadelphia, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Elizabeth Cooney, MPH, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania,