Description of Institution and Program

Using Mayo Clinic - Rochester's (MCR) comprehensive database of inpatient palliative care (PC) consults, we reviewed demographics, consult characteristics, and trends of all 1794 consults performed over the five years since inception of the service.

Goal

To increase our understanding of the referring services and patients we serve as the PC consultation service at MCR and identify areas of practice improvement to provide better interdisciplinary, patient-centered care.

Measures

1. Age: mean, median, range
2. Gender
3. Diagnosis
4. Requesting physician practice group
5. Issues addressed by consultation
6. Time from admission to consultation, consultation to discharge
7. Survival after consultation

Data Collected

To increase our understanding of the hospital teams and patients we serve as the PC consultation service at MCR, we collected demographic, consult-related, and outcomes data on all inpatients consults performed over the initial five years. This database was analyzed to improve our practice and focus educational efforts. Our analysis shows significant annual growth in consults performed since inception with over 500% 5-year growth and predicted growth for 2008 exceeding 2007 by 33%. Patients' median age was 76, with a slight preponderance of males over females (52% and 48% respectively). General medicine, medical cardiology, and medical intensive care unit services were the most common to request services. Most frequent issues addressed during consultation include goals of care, dismissal planning, and pain control. While cancer-related consults predominated (64% of total consults) the first year of service, we have observed a decreasing trend in this population to only 38% and consults for cardiac and other non-neoplastic conditions have significantly increased. Also, despite stable median hospital length of stay annually since 2003, patient time from admission to death is steadily decreasing suggesting that our patients are being admitted with increasing morbidity and earlier mortality. Although consult volume growth has increased dramatically and referring providers are more familiar with our services, time from consultation to death has remained steadfast at 2.5 days and the valuable window of time from consultation to death has also narrowed.

Graphs or Tables of Results

Lesson Learned

The PC consultation service at MCR provides a valuable service to an expanding patient population referred from diverse inpatient teams. Our growth is exponential and the primary diagnoses seen are becoming more varied. We provide multi-faceted care during consultations often involving establishing goals, planning, and symptom control. Areas for improvement include encouraging earlier consultations among the increasingly ill patients admitted to the hospital and future direction involves developing outcome measurements to assess our impact on symptom management, goals of care for patient/families, and length of hospitalization.

• Reflected on our growing, diverse, and changing service noting future challenges in understanding the interdisciplinary needs of non-cancer patients.
• Identified importance of early-placed, efficient, comprehensive, interdisciplinary palliative care consultations to bring our expertise to practitioners, patients, and families.