Department of Emergency Medicine, AdventHealth Orlando, Orlando, Florida, USA.
Department of Clinical Innovation, and AdventHealth Orlando, Orlando, Florida, USA.
J Palliat Med. 2021 Dec;24(12):1776-1782. doi: 10.1089/jpm.2020.0750. Epub 2021 May 20.
The emergency department (ED) is a primary entry point of hospitals but does not have a system to identify and consult palliative care (PC) early in patients who meet criteria. To determine the measurable effects of an ED PC consultation on patients who meet criteria, hypothesizing that ED PC consultation would lead to decreased average length of stay (ALOS), average direct cost per patient, decreased number of surgeries, and radiological tests performed per patient. A physician-led data-driven evidence-based algorithm was designed and piloted with implementation in two hospitals during January-March 2019 in Orlando, FL. A retrospective review of health record data was completed, comparing patients receiving PC consultation ordered in the ED versus those ordered after admission. ED patients ( = 662) met PC criteria. PC consultation was ordered in ED for 80 (12.1%) cases. The following outcomes were lower for patients who received ED PC consultation than those who did not: ALOS by 6.4 days (6.74 vs. 13.14 days; < 0.001), in-hospital mortality (12.5% vs. 19.1%; = 0.11), surgery (11% vs. 37%; < 0.01), radiological tests per patient (4.01 vs. 10.57; < 0.001), and average direct cost per patient ($7,193 vs. $22,354). However, 30-day hospital revisit rates were relatively higher in those who did receive ED PC consultation than those who did not (20% vs. 13% = 0.15). In this pilot project, PC patients can be identified in the ED with an algorithm that leads to earlier consultation and improved patient outcomes. Larger research trials are needed to replicate this strategy and results.
急诊科（ED）是医院的主要入口，但没有系统可以在符合条件的患者中及早识别和咨询姑息治疗（PC）。为了确定 ED 患者 PC 咨询对符合条件的患者的可衡量影响，假设 ED PC 咨询将导致平均住院时间（ALOS）、每位患者的平均直接成本、手术数量和每位患者进行的放射学检查数量减少。设计了一种由医生主导的数据驱动循证算法，并于 2019 年 1 月至 3 月在佛罗里达州奥兰多的两家医院进行了试点和实施。对健康记录数据进行了回顾性审查，比较了在 ED 接受 PC 咨询和在入院后接受 PC 咨询的患者。ED 患者（ = 662）符合 PC 标准。ED 中为 80 例（12.1%）患者下达了 PC 咨询订单。与未接受 ED PC 咨询的患者相比，接受 ED PC 咨询的患者具有以下较低的结果：ALOS 减少 6.4 天（6.74 天比 13.14 天； < 0.001），住院死亡率（12.5%比 19.1%； = 0.11），手术（11%比 37%； < 0.01），每位患者的放射学检查次数（4.01 次比 10.57 次； < 0.001）和每位患者的平均直接成本（7193 美元比 22354 美元）。然而，接受 ED PC 咨询的患者 30 天内再次住院的比例相对较高，高于未接受 ED PC 咨询的患者（20%比 13%； = 0.15）。在这个试点项目中，ED 可以通过一种算法来识别 PC 患者，该算法可以导致更早的咨询和改善患者的预后。需要更大规模的研究试验来复制这一策略和结果。
