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Interdisciplinary Rounds on a Hospitalist Service: Impact on Palliative Care Measures, Quality, and Utilization
Catherine V Smith1, Ralitsa S Maduro, Merri K Morgan
1Nursing Administration, Sentara Williamsburg Regional Medical Center, Williamsburg, Virginia (Dr Smith); Quality Research Institute, Sentara Healthcare, Virginia Beach, Virginia (Drs Maduro, Morgan, and Zimbro and Ms Schneider); and School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Rutledge).
Background:
Despite growth in service availability, palliative care (PC) referrals are often underutilized or delayed, which may compromise patient outcomes.
Local Problem:
Underutilized or delayed PC referrals among hospitalized adults prompted this project aimed at improving PC measures, quality, and utilization outcomes.
Methods:
Data extracted from the electronic medical record were used to identify needed improvements in PC.
Intervention:
Interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting.
Results:
Following implementation, median time to PC referral decreased by 2 days. Length of stay (LOS), direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility.
Conclusions:
Results support IDRs as a mechanism to improve time to PC referral, decrease LOS, direct cost, and 30-day mortality among hospitalized adults. A more objective method of identifying patients with unmet PC needs may be warranted.
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