Palliative care consultation by advanced practice nurse improves the quality of life in congestive heart failure patients
Creators: name: Malast, Tracey
Publisher: name: No Publisher Supplied
Year: 2021

description: Purpose of Project:This project aimed to discover whether initiating early palliative care consultations, at the time of admission to the hospital, would (1) improve the quality of life (QoL) and (2) reduce the number of hospital readmissions for patients with CHF. An electronic trigger in the electronic medical record (EMR), was developed to alert attending physicians when their patients with CHF were admitted to the hospital, so physicians could then refer patients for consult with the palliative care team.Methodology:A convenience sample of patients with CHF was utilized to examine whether early initiation of palliative care in the chronic heart failure population was associated with (1) improved QoL, and (2) reduced hospital readmissions 30 days after first consult. The setting was a 625-bed tertiary acute care academic medical center located in central, New Jersey. The hospital serves central New Jersey counties, as well as patients from nearby states like New York, Pennsylvania, Delaware and New York. Healthcare services include oncology, cardiac, trauma, neuroscience, orthopedics, women’s care, and children's care. During the time this project was completed, the average daily census for the adult population was 525 patients.Results:The palliative care trigger was created and went live in November 2019. The palliative care trigger was activated when a patient was admitted with a sole diagnosis of CHF. However, during the time frame from November 1 to December 1, the ICD codes associated with CHF were not meeting the criteria established for the palliative care trigger. Therefore, the information technology team widened the computerized query to activate the trigger in response to all ICD codes associated with CHF being entered into the EMR upon admission to the hospital. The start date for the new trigger was December 1, 2019. During this second time frame, from December 1, 2019 to February 28, 2020, the palliative care consult trigger was activated 3,487 times. However, only one physician responded to the trigger by referring their patient for a palliative care consult. The Palliative Advance Practitioner (PAPN) who responded to the consult determined that the patient did not meet the inclusion criteria for this project.Implications for Practice:Evidence presented in the prior studies presented in this project demonstrate a critical need for early initiation of palliative care consultations to improve the QoL and lower the readmission rates for patients with CHF. Palliative care guidelines and policies that include measurable goals for enhanced management of this condition, as well as other chronic illnesses, must be established. Additionally, the importance of PAPNs’ influence on patients’ ability to manage their CHF with self-care must be emphasized. Standardized roles of PAPNs and healthcare team collaboration to support chronic illness management must become embedded in the culture. Finally, organizational policies and standardized education on principles of palliative care and chronic illness management for all healthcare teams and the community must be developed and implemented. The integration of early initiation of palliative care consult on admission for the patient diagnosed with CHF could improve QoL and decrease readmissions for the heart failure population. It is essential that our healthcare teams effectively use palliative care services for our chronically ill population. We can start by providing palliative care to our patients with CHF, and expand this service to our patients with other medical conditions.However, only one referral was made to palliative care out of 3,486 patients with CHF who were admitted to the hospital — and that patient was for end-of-life care, and did not meet inclusion criteria for this project. Physicians did not utilize the valuable services that PAPNs offer for patients with CHF. Was this a failure of knowledge or culture? Future studies are needed to address the significant gap in utilization of palliative care that exists among physicians in all specialties.