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Post earlier referrals
Author: Deb
Date: Sep 2, 2008 2:16 pm
I know I have read something on palliative care being more effective when referrals received earlier. I am remembering a number of within 3 days of admit. I can't remember or find where I read this. Am I correct? and does does anyone have reference for this? Or any other studies on early PC involvement? I am writing business proposal and needs ref.
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+ Re:earlier referrals (by SharolHerr on 09/04/2008)
Data has shown that earlier referral to palliative care contributes to cost savings. The savings occur in the following categories: room and board, ancillary costs, pharmacy costs. Therefore, the sooner palliative care gets involved the greater the impact. At VCU and Mt. Carmel we have been able to demonstrate financial cost savings for patients that are directly admitted to an acute palliative care unit or admitted with a consult to palliative care service. Costs of care for patients with later referral to palliative care are more likely to exceed the DRG reimbursement. When patients have been directly admitted to our acute palliative care unit length of stay was approximately 3.5 days. This is the same length of stay for patients that were seen in consult and then transferred to the APCU. The patients seen in consult often have already been in the hospital several days and in ICU or on a telemetry unit. Palliative care plays a significant role in expediting appropriate treatment plan and transitioning to an appropriate level of care. One of the resources on the CAPC website under "Palliative Care Publications" is "The Case for Hospital-Based Palliative Care." I'd encourage you to check it out if you haven't already.

Sharol Herr, RN, MSEd, CHPN
Nurse Clinician/Education Coordinator
Mt. Carmel Health; A CAPC Palliative Care Leadership Center
Columbus, OH
+ Re:earlier referrals (by SharolHerr on 09/10/2008)
Good news! An article was published 9/8/08 in the Archives of Internal Medicine (2008;168(16):1783-1790. "Cost Savings Associated With US Hospital Palliative Care Consultation Programs."

See this link for all of the details:
http://www.capc.org/news-and-events/releases/news-release-9-08-08

Sharol Herr, RN, MSEd, CHPN
Nurse Clinician/Education Coordinator
Mount Carmel Health Palliative Care Leadership Center
Columbus, Ohio
+ Re:earlier referrals (by jbcassel on 11/03/2008)
I agree with everything Sharol said and only add that timeliness in providing PC or hospice care was one of the few domains in which we do not seem to be doing well, as a field. Diane Meier's audio-conference on "Quality Measures 101" a year or two ago, points this out quite dramatically, with a median of 18 days elapsing at Mt Sinai. In the Morrison et al. study (which Sharol cited in her reply), cases were excluded which had a LOS of less than 7 days because of how unlikely it was for patients to receive a PC consult in the first week. In the Twaddle et al. study of academic medical centers, PC consults occurred on average 9 days after admission (if at all). In this context, "earlier" referral would be anything less than a week!... Brian Cassel, VCU PCLC, 804-628-1926, jbcassel@vcu.edu

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