Background:
Palliative care improves quality of life and mortality outcomes in individuals with terminal cancer diagnoses. Yet palliative care is often not made available to these patients in a timely manner, either due to lack of available resources, or physician and patient misconceptions about its purpose and utility. Baseline evaluation at Salem Hospital showed that patients with a <2 year life expectancy received inpatient palliative care consults only 50% of the time. Our goal was to improve access to palliative care consults by initiating a nurse-driven palliative care consult process.
Methods: The target population was defined as inpatients with any Stage IV cancer diagnoses, acute leukemia or lymphoma, or any other cancer patient deemed to potentially benefit from intervention by the nursing staff. The study group was limited to patients admitted to the inpatient oncology unit (5 North) during their hospital stay, while the intervention nursing team was within the same unit. The protocol was four-step process comprised of RN identification of a potential eligible patient, RN call to palliative care team, palliative care verification of eligibility criteria, palliative care MD call to attending MD prior to consult initiation. Education was provided to the oncology nursing, palliative care, oncology and hospitalist provider teams, and acceptance was obtained prior to initiation of project. Baseline data were obtained from retrospective review of last 100 patients discharged from 5 North with a primary malignancy diagnosis prior to initiation of intervention obtained through a query of EPIC data. Intervention began September 1, 2013 and continued through Dec 1, 2013. Follow-up data included all patients admitted to 5 North during the intervention period also obtained via EPIC query. All charts were reviewed to confirm primary diagnosis, stage and acuity, as well as palliative care involvement. Measured outcomes included both quantitative data regarding consult frequency as well as qualitative data looking at patient and nurse satisfaction.
Results:
Palliative care consults for the target population increased 50% during the intervention period, from a baseline of 50% to 77% after intervention. The rise was rapid and began prior to official intervention start, after initial education dissemination. Patients, families and nurses expressed satisfaction with the process with average nursing scores of 9.6/10 to the question of whether protocol provided benefit to their patients and 9.8/10 when asked about whether it increased satisfaction with their role. Patient/family comments about the consult process were uniformly positive.
Conclusions:
Nursing-driven palliative care consults are an effective method of increasing appropriate palliative care utilization and increase nursing satisfaction with their role in patient care. Increased palliative care consults were well received by patients, families and staff. It remains important to foster physician engagement in any process that can be perceived as impinging on physician autonomy.