Palliative Screening to Positively Improve Patient Care
In June 2015 we began 100% screening throughout our Health System by RNs on admission to Medical, Oncology, ICU, and Telemetry units. As data was gathered we recognized an opportunity to do a second screening on patients who had not yet been referred to palliative care (PC). Case Managers now re-screen when the patient’s health status changes or the level of care needs to be upgraded. The screening tool in our Electronic Health Record (EPIC), provided multiple methods of requesting a consult order from the Attending physicians at our organization. The most effective method proved to be the nurse calling or speaking directly with the doctor to identify the value indicated by the positive screening. The nurses felt empowered. We worked with them to use “Situation, Background, Assessment, and Recommendations (SBAR) techniques to communicate the need for a consult. Physicians, who had previously consulted the PC team later in the trajectory of the patient’s illness began considering earlier referrals. Physicians who had not considered the team’s intervention, began thinking about involving palliative providers. The result of this systematic approach led to a consistent growth in PC referrals, incorporation of PC as a ‘standard of care.’ The positive impact on hospital patient satisfaction surveys; improved pain control; nursing satisfaction with Interdisciplinary Team support and co-operation strengthened the program. The hospitalists increased referrals. The hospitals where the programs had already been enculturated progressed more rapidly, both improving length of stay, and lower readmission rates. The hospitals, where PC programs were just starting, improved readmission rates but the length of stay was slightly longer. This result reinforced our belief that early referrals, which occur once enculturation is established, accomplishes both reduced length of stay, reduced readmissions, and subsequently lower medical treatment cost.
- Lynne B. Kennedy, PHD
- Director Palliative Care Inova Health System
- Inova Fair Oaks Hospital
- Service Line Office 3600 Joseph Siewick Drive
- Fairfax, VA 22033
- Vera Dvorak, MD