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Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure

Heart failure is a leading cause of hospitalisations. Integration of palliative care services with medical therapy in the management of hospitalised patients with heart failure is imperative. Unfortunately, there are no standardised criteria for palliative care referrals among hospitalised patients...

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Autores principales: Bhattacharya, Adhiraj, Chakrabarty, Satyaki, Cabrales, Jose, VanHorn, Alixis, Lemoine, Jaclyn, Tsao, Lana, Jaber, Bertrand L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10441042/
https://www.ncbi.nlm.nih.gov/pubmed/37597855
http://dx.doi.org/10.1136/bmjoq-2023-002330
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author Bhattacharya, Adhiraj
Chakrabarty, Satyaki
Cabrales, Jose
VanHorn, Alixis
Lemoine, Jaclyn
Tsao, Lana
Jaber, Bertrand L
author_facet Bhattacharya, Adhiraj
Chakrabarty, Satyaki
Cabrales, Jose
VanHorn, Alixis
Lemoine, Jaclyn
Tsao, Lana
Jaber, Bertrand L
author_sort Bhattacharya, Adhiraj
collection PubMed
description Heart failure is a leading cause of hospitalisations. Integration of palliative care services with medical therapy in the management of hospitalised patients with heart failure is imperative. Unfortunately, there are no standardised criteria for palliative care referrals among hospitalised patients with acute decompensated heart failure. The objective of our quality improvement project was to develop and implement a palliative care consult trigger tool for hospitalised patients with acute decompensated heart failure. We found that among eligible patients, palliative care referrals were underused, likely contributing to misalignment of goals of care and suboptimal advance care planning. We developed a trigger tool and designed and implemented structured multicomponent educational interventions to improve the appropriateness and timeliness of inpatient palliative care consultations in this high-risk population. The educational interventions led to a significant increase in the rate of appropriate inpatient palliative care consultations among hospitalised patients with acute decompensated heart failure (46.3% vs 27.7%; p=0.02). In addition, palliative care referrals resulted in better alignment of goals of care at the time of hospital discharge, as measured by a significant increase in the completion rate of a healthcare proxy form (11.4% vs 47.2%; p<0.001) and a Medical Order for Life-Sustaining Treatment form (2.0% vs 24.1%; p<0.001), as well as the establishment of a Do-Not-Resuscitate order (2.7% vs 29.6%; p<0.001). Furthermore, the intervention resulted in a significant decrease in the hospital readmission rate up to 90 days post-discharge (43.6% vs 8.3%; p<0.001). This quality improvement project calls for the development and adoption of standardised criteria for palliative care referrals to benefit hospitalised patients with heart failure and reduce symptom burden, align goals of care and improve quality of life.
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spelling pubmed-104410422023-08-22 Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure Bhattacharya, Adhiraj Chakrabarty, Satyaki Cabrales, Jose VanHorn, Alixis Lemoine, Jaclyn Tsao, Lana Jaber, Bertrand L BMJ Open Qual Quality Improvement Report Heart failure is a leading cause of hospitalisations. Integration of palliative care services with medical therapy in the management of hospitalised patients with heart failure is imperative. Unfortunately, there are no standardised criteria for palliative care referrals among hospitalised patients with acute decompensated heart failure. The objective of our quality improvement project was to develop and implement a palliative care consult trigger tool for hospitalised patients with acute decompensated heart failure. We found that among eligible patients, palliative care referrals were underused, likely contributing to misalignment of goals of care and suboptimal advance care planning. We developed a trigger tool and designed and implemented structured multicomponent educational interventions to improve the appropriateness and timeliness of inpatient palliative care consultations in this high-risk population. The educational interventions led to a significant increase in the rate of appropriate inpatient palliative care consultations among hospitalised patients with acute decompensated heart failure (46.3% vs 27.7%; p=0.02). In addition, palliative care referrals resulted in better alignment of goals of care at the time of hospital discharge, as measured by a significant increase in the completion rate of a healthcare proxy form (11.4% vs 47.2%; p<0.001) and a Medical Order for Life-Sustaining Treatment form (2.0% vs 24.1%; p<0.001), as well as the establishment of a Do-Not-Resuscitate order (2.7% vs 29.6%; p<0.001). Furthermore, the intervention resulted in a significant decrease in the hospital readmission rate up to 90 days post-discharge (43.6% vs 8.3%; p<0.001). This quality improvement project calls for the development and adoption of standardised criteria for palliative care referrals to benefit hospitalised patients with heart failure and reduce symptom burden, align goals of care and improve quality of life. BMJ Publishing Group 2023-08-18 /pmc/articles/PMC10441042/ /pubmed/37597855 http://dx.doi.org/10.1136/bmjoq-2023-002330 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Bhattacharya, Adhiraj
Chakrabarty, Satyaki
Cabrales, Jose
VanHorn, Alixis
Lemoine, Jaclyn
Tsao, Lana
Jaber, Bertrand L
Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title_full Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title_fullStr Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title_full_unstemmed Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title_short Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
title_sort implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10441042/
https://www.ncbi.nlm.nih.gov/pubmed/37597855
http://dx.doi.org/10.1136/bmjoq-2023-002330
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