This document summarizes data from 136 palliative care patients seen by the Palliative Care Quality Network between November 8-9, 2012. Key findings include: - The average age of patients was 74 years old and over half were female. Most referrals came from medical/surgical units and were for symptom management, pain management, or advance care planning. - Cancer was the most common primary diagnosis. Documentation of goals of care and code status varied between hospitals. Multidisciplinary teams including nurses, doctors, and social workers provided consultations. - Pain, anxiety, and dyspnea were the most common initial symptoms. Symptoms improved for most patients within 24 hours of the palliative care consultation

1. Palliative Care Quality Network
November 8-9, 2012
Steven Pantilat, MD
Director, Palliative Care Quality Network

2. Patient characteristics
Characteristics
Number of patients 136
Symptom Assessments Mean= 2.1, median=1.0, range= 0 – 13
Age (Years) Mean=74, Median=78, Range: 23 – 99
Gender (Female) 54.1% (73/135)
LOS pre referral (Days) Mean= 4.6, Median= 2.0, Range: 0 – 47

3. Location at time of the referral
Other
Acute rehab
Referral Location
SNF
Emergency Dpt
Telemetry Step/down
Critical care
Med Surg.
0 10 20 30 40 50
Frequency (%)

4. Critical care referrals by hospital
60
50
50 45
Frequency (%)
40
30 28
20
20 18
10 5
0
1 2 3 4 5 Mean
Hospital

5. Reasons for referral
Other
Comfort care
Reason for referral
Transfer to CCS
Withdraw life prolong. Intervent.
Symptom manage.
Pain manage.
Advance care plan.
Goals of care
Hospice referral
0 10 20 30 40 50
Frequency (%)

6. Referred for pain management by
hospital
50
p=0.03
40
Frequency (%)
30 28 27
21
20 17
15
10
0
0
1 2 3 4 5 Mean
Hospitals

7. Primary diagnosis
Other
Gastro
Vascular
Primary Diagnosis
Hepatic
Pulmonary
Renal
Complex Cond.
Dementia
Neurologic
Cardiac
Infectious
Cancer
0 10 20 30 40 50
Frequency (%)

8. Proportion of patients diagnosed with
cancer
p= 0.007
50 46 46
40
40 38
35
Frequency (%)
30
20
10 7
0
1 2 3 4 5 Mean
Hospital

9. Documentation of desired care
60 60
50
50 45 50
Frequency (%)
40 40
30 30
20 20 15
10
10 5 10
0 0
Full Partial DNR/DNI Adv. direct. POLST
Code Status (n=130) N= 136

10. Disciplines involved in consultation
Other
CNS
Disciplines
NP
Chaplain
RN
SW
MD
0 10 20 30 40 50 60 70 80 90 100
Frequency (%)

11. Number of disciplines per consultations
50
41
40
Frequency (%)
30
20 18 18
14
10 7
2
0
0 1 2 3 4 5
Number of disciplines involved in consultation

12. Disciplines per consultation for each
hospital
p= 0.005
5
Disciplines per consultation
4
3 3
3
2 2 2
2
1
1
0
1 2 3 4 5 Mean
Hospital

13. Family meetings per hospital
p= 0.001
5
Number of family meetings
4
3
3
2 2 2
2
1 1
1
0
1 2 3 4 5 Mean
Hospital

14. Mean palliative performance scale
p= 0.002
100
80
Frequency (%)
60 53
38 39 39
40 35
32
20
0
1 2 3 4 5 Mean
Hospital

15. Discharge disposition (N= 117)
Other
Died before consultation
Disposition
LTAC
Inpatient
Died
ECF
Home
0 10 20 30 40 50
Frequency (%)

16. Proportion of patients that died per
hospital
p= 0.003
50 46
40
Frequency (%)
30
19
20 16 17
10 7 6
0
1 2 3 4 5 Mean
Hospital

17. Assessment of symptoms (n= 136)
Symptom Assessed Addressed %
(n) (n)
Pain 98 57 58
Non-Pain symptom 102 62 61
Psychosocial 105 69 66
Spiritual 84 53 63

18. Desired care clarified or completed
60
53
50
Frequency (%)
40
30
20
13
10
3
0
Code status Adv. Direct. POLST
Documentation

19. Initial Symptom Assessment
100
n= 119 n= 119 n= 118 n= 117
80
Frequency (%)
60
43 25 12 21
40
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20
0
Pain Anxiety Nausea Dyspnea
Symptom
None Mild Moderate Severe Unable to report

20. Improvement in symptom 24 hrs. after
initial assessment
100
n= 26 n= 9 n= 5 n= 7
80
Frequency (%)
56 60 57
60
44 43
39
40
23 23 20 20
20 15
0
Pain Anxiety Nausea Dyspnea
Symptom
Worse 1-point No Change Improved 1-point Improved 2-points

21. Proportion of patients ‘unable to report
pain’ per hospital
p= 0.003
50
40
Frequency (%)
33
30 27
21
20 16
10
4
0
0
1 2 3 4 5 Mean
Hospitals