More hospitalized patients can receive earlier palliative care if a provider programs automated orders into the electronic medical record (EMR).
By using this process, researchers at Penn Medicine increased palliative care consultation rates in the hospital to 43.9%, up from 16.6%, according to a study published today in JAMA. This method also reduced the time to consultation by 1.2 days, the study found. Researchers indicated that this was the largest study to date on inpatient palliative care.
“While early palliative care consultation could help many patients with chronic serious illnesses better understand their diagnosis and align their treatment choices to their individual care goals, there’s never been an established approach to realizing that goal at scale. We found that a simple, pre-programmed order within the electronic medical record can get more palliative care to more people more quickly,” said lead author Dr. Kate Courtright, assistant professor of critical care and palliative medicine at Penn, in a statement. “This strategy was low-cost and easily implemented in community hospitals, which is where most Americans receive their health care.”
The study included more than 34,000 patients with chronic obstructive pulmonary disease (COPD), dementia or kidney failure at 11 hospitals in eight states. Patients with these conditions are often under-represented in past studies of palliative care delivery, according to researchers. These patients often experience emotional distress, breathlessness, anxiety, pain and other symptoms that palliative care can help ameliorate.
The study took place between March 2018 and November 2018. If necessary, a physician would have the option to cancel the automated order, but this occurred in fewer than 10% of the patients involved in the study.
“Our results suggest that the default order strategy was generally acceptable to clinicians, which is important because if we want to reach as many eligible patients as possible, we need to design approaches that are feasible for ‘real-world’ practice and not just in the research setting,” Courtright said.
