M. J. Keating1, N. D. Patel1, M. Nishtala1, C. W. Towe1, C. S. Koniaris2, J. George2, V. P. Ho1 1Case Western Reserve University School Of Medicine,Surgery,Cleveland, OH, USA 2Case Western Reserve University School Of Medicine,Medicine,Cleveland, OH, USA
Introduction:
Palliative care is a medical specialty focused on improving quality of life and alleviating symptoms for patients facing life-threatening illness. Barriers to the integration of Palliative Care team (PCT) services into the care of trauma patients have not been clearly defined. We sought to prospectively evaluate whether trauma team (TT) and PCT members differed regarding perceived benefit of PCT (PBP) consultation in trauma patient care.
Methods:
TT and PCT clinicians attended weekday trauma service sign out for 12 weeks. Based on verbal report, each member of the TT and PCT independently assessed whether patients might benefit from a PCT consultation. TT included trauma surgeons (TS), advance practice providers (APPs), and residents. Sign out typically involved 4-6 TT members. PCT included physicians and APPs; sign out typically involved 1-2 PCT members. Data were prospectively collected regarding assessments, demographics, injury severity, and outcomes. Patients who received a PCT consult were excluded from subsequent assessments. PBP between the TT and PCT clinicians was compared. Secondarily, we sought to identify clinical outcomes associated with PBP. Chi-square and Student’s t-test were used to compare groups (p<0.05 considered significant).
Results:
186 patients (median age 47.6, SD 23.9) had 2013 assessments performed by TT members and 522 assessments by PCT members. Mean injury severity score was 11.9 (SD 9.9). Mean length of stay was 5 days (SD 10.9). There were 5 deaths. TT members identified 76 patients (41%) as having PBP at least once during the hospital stay, compared with 59 patients (32%) identified by PCT (p<0.001), with 78% concordance. TS identified fewer patients with PBP than PCT (22% vs 32%, p<0.001), with 49% concordance with PCT. Eight (5%) patients received a formal PCT consult. Patients identified as having PBP by any clinician were significantly more likely to change code status to “Do Not Resuscitate,” and were more likely to be discharged to a destination other than home.
Conclusion:
TT and PCT providers identify a high proportion of trauma patients who might benefit from PCT evaluation. Despite this, consultations are rarely requested. Further exploration should be performed to determine barriers to PCT consultation.