A study published in the journal Critical Care Nurse posits that “a simple screening tool integrated into the admissions process for critically ill patients can streamline requests for palliative care consultations.”
An initiative was tested at a community hospital in Cincinnati in an attempt to “improve the process of requesting palliative care consultations,” for which there remains no standardized method. The project team in Cincinnati “used clinical indicators as the foundation of the screening tool,” designing a “flow sheet in the electronic health record to be completed by the nurse within 24 hours of admission.”
The tool itself contains 12 comorbidities and seven contributing factors, each accumulating one “point” for an affirmative response by the patient. Previous ICU admission within three months and hospital readmissions within 30 days also accumulate two points each. In the end, “a total score of four or greater indicates referral to palliative care and triggers an automatic request for a consult.”
31 of the 267 patients admitted during the project period received referrals for palliative care consultations using “the traditional process.” However, applying the screening tool to the documented data “resulted in 59 patients with positive scores that would have triggered a consultation request earlier in their hospital stays.”
35 patients were “discharged to skilled nursing facilities” over the project period. Of those, only six received referrals for palliative care using the traditional process, but “17 would have received one as a result of their scores with the screening tool. … Of the 11 patients discharged to skilled nursing facilities who did not receive palliative care consults during their hospital stays but whose scores indicated they would have received referrals, nine had poor outcomes.”
The AACN’s website has the news release.
