Implementation of a Palliative Care Screening Tool on a Medical-Surgical Inpatient Unit: A Pilot Study

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Fylling, Melanie
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Purpose: The purpose of this pilot study was to implement a palliative care trigger list to identify inpatients on the medical-surgical units who may benefit from a palliative care consult. Background Palliative care is currently underutilized and according to the Center to Advance Palliative Care (2014), six million patients could take advantage of the palliative care specialty. Increasing the number of palliative care teams nationwide and promote palliative care consults can improve the quality of life for patients living with serious illnesses. Significance Healthy People 2020 has called for increasing the quality of life in relation to health. The World Health Organization (2014) has urged states to provide funding for palliative care services and to address legislation. Problem Palliative care consults are currently underutilized and based on individual physician discretion.|Methodology: A palliative care trigger list was created based on current research, organization's past trigger list, and expert opinion. The trigger list was applied through a prospective electronic medical record review of adult patients admitted to a medical-surgical inpatient unit. Results Of those needing a palliative consult, 100% of patients were captured (CI 95%=[63,100]). Of those who screened as needing a consult, 13% of patients really did (CI 95%=[11,16]). Given they did not need a consultation, 75% screened as not needing a consult (CI 95%=[68,80]). The tool was then analyzed with the removal of trigger 11. Given they needed a consultation, 63% screened as needing a consultation (CI 95%=[24, 91]). Given they didn't need a consultation, 88% screened as not needing a consultation (CI 95%=[83, 92]). Of those who screened as needing a consultation, 17% really did (CI 95%=[9, 28]). Of those who screened as not needing a consultation, 98% really did not (CI 95%=[96, 99]).|Conclusion: The original trigger list was able to identify every patient that could benefit from a palliative care consults but was very sensitive. The revised list captured 63% of those needing a consult but was less sensitive.|Key words: palliative care, consults, trigger list, screening tool
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