M. C. Turner1, B. C. Evans3, C. Sommer1, L. Pickett1, A. Galanos2 1Duke University Medical Center,Surgery,Durham, NC, USA 2Duke University Medical Center,Medicine,Durham, NC, USA 3Duke University Medical Center,School Of Medicine,Durham, NC, USA
Introduction: The American College of Surgeons(ACS) recommends surgeons collaborate with palliative care specialists for surgical patients with poor prognosis to discuss symptom management, goals of care, and end of life decision-making. However, contemporary practice patterns of palliative care consultation for surgical patients is poorly defined. We aim to describe the use of palliative care consultation for patients admitted to surgical services who died in the hospital during their index admission. We hypothesize there is insufficient use of palliative care consultation in these patients at our institution.
Methods:
The Duke Enterprise Data Unified Content Explorer (DEDUCE) 2014-2016 was queried for patients admitted to general surgery services who died in the hospital. The primary endpoints of palliative care consultation was obtained from chart review. Secondary measures included admitting service, operative vs nonoperative, length of stay, total time spent in consultation, days from consultation to death, and agreement and execution of a care plan. This project was granted exemption from the IRB as a Quality Improvement Initiative.
Results: Of the 105 patients identified, 6 died on the day of admission, and 39 (37%) received a palliative care consultation. Patients who received consultation were older, white, insured, and admitted to the vascular service. Of the patients who received consultation, a median of 60 minutes (Interquartile Range (IQR):30-110) was spent by the consulting team with the patient/family. Patients who received consultation had a median length of stay of 18 days (IQR:9-27) compared to those without (4d IQR: 1-14). The median number of days between palliative consult and death was 3 days (IQR: 1-8). Goals of care was the indication for consultation in 62.5% of patients. The proposed plan by the consultants was congruent with the primary team in 66.7% of cases.
Conclusion: Palliative care consultation was underutilized in surgical patients who died in the hospital at our institution. Identification of barriers to consultation and promotion of the benefits of palliative care among surgical teams is warranted. Further investigation into family satisfaction and cost of care will be important in future prospective studies.
