Earlier Palliative Care Referrals Associated with Reduced Length of Stay and Hospital Charges.

Inpatient palliative care consultation services have been shown to have a dramatic impact on the time cancer patients spend in the hospital, which directly affects overall health care charges and expenditures. Our study looks at early palliative care consults in patients with a variety of chronic medical conditions as well as cancer. This is a retrospective case-control study of patients referred to the palliative care department from April 2014 to June 2016. This study took place at a university-affiliated community-based urban tertiary care hospital. Cases were patients with a referral placed for a palliative care consult <24 hours after registration into the hospital. Controls were chosen on a one-to-one basis from all other patients referred 24 or more hours after registration. Participants were matched on underlying disease, Charlson comorbidity index, and date of referral. Primary outcomes were hospital length of stay and total hospital charges. The median (interquartile range) length of stay was 4.2 days (2.0-7.2) for cases and 9.7 days (6.0-18.3) for the control group;  < 0.001. Total hospital charges in U.S. dollars for cases and controls was $38,600 ($22,700-$66,900) and $95,300 ($55,200-$192,700), respectively;  < 0.001. Similar differences were seen for cancer and chronic disease cases and controls. Our study demonstrates a significant association between reduced length of stay and hospital charges when consults for palliative care were initiated within 24 hours of hospital admission regardless of underlying disease.