Background: Reducing LOS promotes value, and when aligned with patient preferences, can improve care. Patients referred for palliative care (PC) generally have longer length of stay (LOS) due to their serious illness, multiple complex management issues, and the fact that long LOS is a reason for engaging a specialty PC team. The aim of this study is to examine the impact of specialty PC on hospital LOS.
Methods: The Palliative Care Quality Network (PCQN) is a national quality improvement collaborative of PC teams that prospectively collect a core dataset on every patient seen. The PCQN data elements include demographics, advanced care planning, and patient-reported symptom management. We analyzed data on 48,290 patient encounters from 71 PCQN member teams collected between January 3, 2012 and June 30, 2016.
Results: Overall, PC patients spent 9.7 days (median= 6.0; range: 0 – 743) in the hospital. Of which, 4.7 days were prior to PC referral (median= 2.0; range: 0 – 467), and 5.1 days were on PC (median= 3.0; range: 0 – 738). Patients spent longer on PC if they were referred for goals of care/advanced care planning (5.4 vs. 4.4; p< 0.0001); pain management (5.7 vs. 5.0; p< 0.0001); and other symptom management (5.5 vs. 5.1; p= 0.002). Patients had a shorter LOS on PCS if they were referred for withdrawal of interventions (4.6 vs. 5.3; p= 0.02), comfort care (3.1 vs. 5.4; p<0.0001), or for referral to hospice (3.9 vs. 5.5; p<0.0001). Patients who reported an improvement in their moderate-severe symptoms had a shorter LOS on PC: pain (7.0 vs. 8.4; p<0.0001), anxiety (6.6 vs. 8.9; p<0.0001), and nausea (7.1 vs. 8.5; p=0.03), but not dyspnea (6.2 vs. 6.6; p=0.5).
Conclusions: We found that patients are referred to PC after almost 5 days in the hospital and spend another 5 days on the PCS. As would be expected, referrals for goals of care and symptom management take longer as these issues can be sensitive and complex in nature. PC teams are more efficient with withdrawal of interventions and referral to hospice. Improvement of distressing symptoms is associated with a shorter PC LOS. Routine screening and proactive referral of patients with serious illness to PC early in the hospitalization is a strategy that could reduce hospital LOS while improving care by facilitating complex conversations and referrals to hospice and providing timely relief of symptoms.