Hospital Readmissions in Hospice Patients: Evaluation of Medication-Related Causes for Readmission

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120959641 ◽

2020 ◽

pp. 104990912095964

Author(s):

Joanna DeAngelis ◽

Maria Felton Lowry

Keyword(s):

Palliative Care ◽

Hospital Readmissions ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Washington Dc ◽

Close Monitoring ◽

Included Patient ◽

Palliative Care Teams ◽

Hospice Patients ◽

Medication Changes

Context: Hospital readmissions, frequent medication changes, and polypharmacy are common issues for hospice patients. It is important to consider if close monitoring of medications by pharmacists could help these patients avoid hospital readmissions. Objective: The objectives of this study were to determine the incidence and types of medication-related problems that contributed to hospital readmissions from hospice settings. Methods: A retrospective chart review was conducted from October 1, 2018 to January 31, 2020. Patients admitted from hospice settings (i.e. Home, ALF, LTCF) and who were seen by the palliative care teams at 9 Maryland and Washington DC MedStar hospitals were included. Demographic information was collected: age, gender, race, primary hospice diagnosis, prognosis determined by provider prior to hospice disposition, reason for readmission, and medication list at readmission. The primary outcomes were the incidence and types of medication-related problems. Secondary outcomes included patient characteristics associated with readmission, and classes/number of medications changed before readmission. Descriptive statistics were used to analyze data. Results: Seventy-five hospice patients were readmitted and seen by palliative care during the study period. Forty-three patients (57%) were found to have medication-related problems at readmission. The most common problem identified was needing additional drug therapy. Dose too low, dose too high, incorrect drugs, adverse drug reactions, and non-adherence were also identified. Additional reasons for readmission were: unanticipated new medical issue (n = 46, 61%) and uncontrolled symptoms (n = 34, 34%). Conclusions: These findings suggest that deprescribing practices possibly contributeto readmissions from hospice settings.

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The recognition and documentation of delirium in hospital palliative care inpatients

Palliative & Supportive Care ◽

10.1017/s1478951509990873 ◽

2010 ◽

Vol 8 (2) ◽

pp. 133-136 ◽

Cited By ~ 29

Author(s):

Julia Barnes ◽

Suzanne Kite ◽

Manoj Kumar

Keyword(s):

Palliative Care ◽

Care Setting ◽

Assessment Tool ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Confusion Assessment Method ◽

Assessment Method ◽

Clinical Syndrome ◽

Palliative Care Teams ◽

Palliative Care Setting

AbstractObjective:Delirium is a clinical syndrome that is known to be under recognized by palliative care teams. A wide variation in reported prevalence may reflect differences in definitions and assessment methods, patient characteristics, and study design. The aim of this study was to test an intervention to improve recognition of delirium in the inpatient palliative care setting.Method:We conducted a retrospective palliative care notes review of documented prevalence of delirium among 61 patients referred to the Specialist Palliative Care Advisory Team (SPCT). Subsequently, training in the use of the Confusion Assessment Method (CAM) was provided to the SPCT and a prospective survey of the prevalence of delirium measured by the CAM was undertaken with the next 59 patients referred.Results:In the retrospective chart review, the term “delirium” was not used, and synonyms were identified and used to establish a delirium prevalence of 11.5%. In the intervention utilizing the CAM in a prospective sample of 59 referred patients, a prevalence rate of 8.5–15.2% for delirium was found. Use of the CAM was received favorably by the SPCT.Significance of Results:The institution of the use of the CAM as a screening and assessment tool in the inpatient palliative care setting did not significantly increase the recognition of delirium. Reasons for the low prevalence of delirium are discussed.

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256. Optimizing the Clinical Utilization of T2 Rapid Candida Panel at a Large Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.331 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S142-S143

Author(s):

Elizabeth Thottacherry ◽

Gladys T Heard ◽

Taylor D Steuber ◽

Ali Hassoun ◽

Adam J Sawyer ◽

...

Keyword(s):

Blood Culture ◽

Community Hospital ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Practical Utilization ◽

Large Community ◽

Clinical Utilization ◽

Time Sensitivity ◽

Included Patient ◽

Appropriate Therapy

Abstract Background Candidemia is the fourth leading hospital-acquired bloodstream infection with an estimated mortality rate of 35%. Fungal blood cultures result in at least five days and fail to identify 40% of Candida infections. The T2 Candida Panel is a diagnostic test which utilizes whole blood to provide rapid detection of five Candida varieties. It has a 91% sensitivity and 99% specificity rate and enables physicians to initiate or de-escalate therapy rapidly, possibly decreasing mortality. However, practical utilization clinically has not been studied. Our aim is to evaluate the appropriate utilization of the T2 Candida Panel in a large community hospital. Methods A retrospective chart review of hospitalized with a T2 Candida Panel result from December 2015 to June 2018 was performed. The panel was restricted and could only be ordered by two specialties, Infectious Disease and Oncology. Baseline demographics and patient characteristics were collected. Endpoints assessed included patient outcomes, antifungal medication use, T2 Candida panel results, corresponding blood culture results, time to appropriate therapy and duration of therapy. Results A total of 628 T2 Candida panels resulted during the study period with 56.6% involving the intensive care setting. The average age was 59.5 years with 52.5% of the population being male. Of the total, 8.1% (n = 60) were positive. Only three patients had a positive fungal blood culture result with a negative T2 panel collected at the same time (sensitivity 94.3%, 95% CI 80.8–99.3; specificity 94.2%, 95% CI 91.4–96.3). 264 (42%) were ordered with concomitant antifungal therapy and 48.1% underwent de-escalation of therapy based on T2 result. The average time to de-escalation was 137 hours. Of the positive results, 40 (66.7%) had an antifungal ordered when the T2 panel was ordered and 30 (50%) were switched to appropriate therapy after T2 resulted in an average time of 11 hours. Conclusion Our data shows that while the T2 Candida Panel demonstrated faster and more sensitive results, there was still a considerable delay in achieving appropriate therapy. The variation in utilization of the T2 Candida Panel indicates that further intervention regarding appropriate use of the panel is required. Disclosures All authors: No reported disclosures.

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Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.165 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 165-165

Author(s):

Ali John Zarrabi ◽

Karen Armstrong ◽

Kimberly A. Curseen ◽

Tammie E. Quest

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Hospital Readmissions ◽

Retrospective Chart Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Nursing Facilities ◽

Skilled Nursing ◽

Commercial Insurance ◽

Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

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Review of a Home-Based Palliative Care Program for Children with Malignant and Non-Malignant Diseases

Journal of Palliative Care ◽

10.1177/082585979701300405 ◽

1997 ◽

Vol 13 (4) ◽

pp. 28-33 ◽

Cited By ~ 21

Author(s):

Ernest A. Kopecky ◽

Sheila Jacobson ◽

Prashant Joshi ◽

Maria Martin ◽

Gideon Koren

Keyword(s):

Palliative Care ◽

Tertiary Care ◽

Care Facility ◽

Retrospective Chart Review ◽

Care Program ◽

Patient Characteristics ◽

Palliative Care Program ◽

Tertiary Care Facility ◽

Home Based ◽

At Home

This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986–1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 ± 0.51 years and mean age at death was 5.3 ± 0.55 years. The mean number of days in hospital was 26.5 ± 14.6 while days spent at home averaged 98.4 ± 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 ± 0.9 by pager and 24.0 ± 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.

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Outcomes of 157 V-Patch™ Implants in the Repair of Umbilical, Epigastric, and Incisional Hernias

The American Surgeon ◽

10.1177/000313481608200105 ◽

2016 ◽

Vol 82 (1) ◽

pp. 6-10 ◽

Cited By ~ 1

Author(s):

Jane J. Keating ◽

Gregory T. Kennedy ◽

Jashodeep Datta ◽

Alan Schuricht

Keyword(s):

Enterocutaneous Fistula ◽

Laparoscopic Approach ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Suture Technique ◽

Recurrent Inguinal Hernia ◽

Complication Rates ◽

Recurrence Rates ◽

Incisional Hernias ◽

Included Patient

Umbilical, epigastric, and incisional hernias have traditionally been repaired using a Mayo or tensioned suture technique, with recurrence rates of approximately 50 per cent. Recent studies have shown that a tension-free repair using mesh can drastically decrease recurrence rates. Reinforced deployment prostheses are preferred because they enable retrofascial placement through a small incision, thus avoiding the potential morbidity of a larger incision and the costs associated with a laparoscopic approach. A retrospective chart review was performed of all umbilical, epigastric and incisional hernias repaired with V-Patch, a reinforced deployment prosthesis, by a single surgeon. Data analysis included patient characteristics, operative and postoperative metrics, hernia recurrence, and complication rates. Between 2009 and 2012, 157 implantations were performed in 152 patients during 156 procedures. Patient age ranged from 20 to 85 (mean 48). There were 88 females (57.9%) and 64 males (42.1%) with average body mass index of 30.6. Patch size distribution was 78 small (49.7%), 55 medium (35.0%), and 24 large (15.3%). There were 81 umbilical hernias (51.6%), 36 epigastric hernias (22.9%), 39 incisional hernias (24.8%), and 1 multiple recurrent inguinal hernia (0.6%) repaired. Follow-up time ranged from 18 months to 4.3 years. There were six hernia recurrences (3.2%). Complications included three patients (1.9%) with mesh infection, one with an enterocutaneous fistula (0.6%), and one patient with a postoperative small bowel obstruction (0.6%). Four patients required patch explantation (2.5%). The V-Patch reinforced deployment prosthesis is effective in the treatment of umbilical, epigastric, and incisional hernias, and has a low rate of complications.

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Differences between Transdermal Fentanyl and Buprenorphine in the Elderly Hospice Patients

Pain Research and Treatment ◽

10.1155/2018/8610538 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Marin Golčić ◽

Renata Dobrila-Dintinjana ◽

Goran Golčić ◽

Lidija Gović-Golčić

Keyword(s):

Palliative Care ◽

Daily Life ◽

Patient Characteristics ◽

The Elderly ◽

Terminal Cancer ◽

Fentanyl Patch ◽

Transdermal Fentanyl ◽

Hospice Patients ◽

Transdermal Opioids ◽

Relationship Of

Introduction. Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. However, studies have shown a controversial relationship of opioids to survival and a rise in deaths associated with the use of transdermal opioids. Although applying precise doses is paramount, we have no clear recommendations for the exact equianalgesic ratio for buprenorphine patch and no recommendation for the type of transdermal opioid to use in hospice. Methods. We analyzed the differences between the transdermal fentanyl and buprenorphine group by analyzing patient characteristics and evaluating the differences in survival in hospice patients over the age of 65, from 2013 to 2017. Results. A total of 292 patients (75.8%) used fentanyl patch and 93 (24.1%) were on buprenorphine patch. Patients had virtually the same characteristics in both groups. However, when using a 1:100 buprenorphine equianalgesic ratio, there were significant differences in initial and final doses, and it seems that a 1:80 conversion rate is more accurate for elderly hospice patients. Finally, there was no difference in survival between the two groups using transdermal opioids, with or without adjuvant analgesics. Discussion. There were no differences in survival between the group using transdermal fentanyl and the group using buprenorphine in the elderly hospice population. Although adjuvant NSAIDs could be useful in the treatment of pain in terminal cancer, they do not affect survival or reduce the opioid doses, while a 1:80 equianalgesic ratio of buprenorphine might be the most appropriate in this population.

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Palliative care screening tool: Does utilization promote early integration of palliative care for inpatient oncology patients?

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.43 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 43-43

Author(s):

Michelle Farnan ◽

Erica Smeltz ◽

Susan Glod ◽

Nancy Parson ◽

Margaret Kreher

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Screening Tool ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Readmission Rates ◽

Oncology Patients ◽

Early Integration ◽

Risk Patients ◽

Embedded Pc

43 Background: Early integration of specialty Palliative Care (PC) in cancer patients improves quality of life and lowers medical costs. Engaging cancer patients early remains challenging. A checklist approach that evaluates type of malignancy, comorbidities, functional status, uncontrolled symptoms, readmission rates, and psychosocial/spiritual distress may prompt consultation to the PC team. We evaluated a palliative care screening tool’s (PCST) effect on promoting early PC consultation for oncology inpatients. Methods: A modified version of the Center to Advance Palliative Care screening tool was utilized by our hospital as part of the admission assessment. Registered nurses completed the PCST within 24 hours of admission for all adults. A PCST score of 3 or higher prompted staff to suggest a PC consult. A retrospective chart review of oncology patients who received a PC consult was performed to assess whether the screening tool score within 24 hours of admission impacted timing of a consult order. Effective tool utilization was considered to be a consult order within 36 hours of a high risk screen score. Results: From January through March 2014, 215 cancer patients screened with the PCST were found to have a score of 3 or higher. Seventy seven percent scored a 3 or higher, and PC consultation occurred in 16% of that patient cohort. Twenty three percent of PC consults occurred in patients scoring less than 3. The average number of days from admission to PC consult was 6 days. Conclusions: Using a PCST did not trigger PC consultation for inpatient cancer patients. Thirty four percent of the screened patients died during that admission, indicating a dramatic change in status from admission or ineffective prognostication, both barriers to early integration of PC. Our work suggests that a screening tool alone, even in a center with a well-embedded PC program, is not a sufficient means of effectively integrating PC into a patient’s hospital stay. Further work to identify patient characteristics that lead to consultation in both high and low risk patients is necessary.

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