Identification of Hospitalized Patients Who May Benefit from a Serious Illness Conversation Using the Readmission...

Area of Science:

• Healthcare Quality Improvement
• Palliative Care Research
• Clinical Informatics

Background:

• Identifying patients who would benefit from serious illness conversations (SICs) presents a significant clinical challenge.
• Electronic health record (EHR) data, such as Epic's Risk of Readmission Score (RRS), may aid in this identification process.
• Prognostic screening tools are needed to guide conversations about serious illness.

Purpose of the Study:

• To determine if Epic's Risk of Readmission Score (RRS) combined with the "surprise question" prognostic screen can identify hospitalized patients needing a serious illness conversation (SIC).

Main Methods:

• A retrospective study randomly selected 202 patient encounters from January 2019 to October 2021 with an RRS > 28%.
• Two adjudicators independently reviewed charts to answer the "surprise question" (Would you be surprised if the patient died in the next 12 months?).
• Fisher's exact test compared standardized SIC documentation rates between prognostic groups.

Main Results:

• Of 202 selected encounters, 77.2% (156 patients) answered "no" to the surprise question, indicating a predicted lifespan under 12 months.
• Patients answering "no" were older, had higher comorbidity, and were more likely to have documented SICs (9.0% vs. 0.0%, p=0.042).
• Despite high-risk predictions, documented SICs were infrequent.

Conclusions:

• A significant proportion of hospitalized patients with high RRS scores may benefit from a serious illness conversation (SIC).
• Combining EHR data (RRS) with a simple prognostic screen (surprise question) shows promise for identifying patients needing SICs.
• Initiatives focused on quality improvement could leverage these tools to increase the rate of essential serious illness conversations.