A Survey to Characterize the Palliative Care Needs of All Hospitalized Patients in an Academic Medical Center

Outcomes 1. Participants will reflect on the process by which patients are brought to inpatient consult services' attention and will imagine alternative systems that would help identify PC appropriate patients more promptly and proactively. 2. Learners will examine the ways in which bias and inequity may affect which patients are referred to subspecialty PC in our current system and compare how interdisciplinary team members may perceive patients' PC needs differently. Key Message Due to reliance on referrals for consults, the true quantity and quality of palliative care (PC) needs in an inpatient population are unknown. This work describes the process and outcomes of a screen to characterize PC needs in one medical center. It demonstrated significant unmet need and underscores the need for a more proactive and systematic model for PC delivery. Introduction Due to reliance on referral-based systems for identifying patients, many inpatient palliative care (PC) services are unaware of the true quantity and quality of need at their institutions. Objectives Screen all hospitalized patients at a large academic medical center to provide a snapshot of patients' quantity and quality of PC needs at one moment in time. Methods A validated EMR-based algorithm for identifying hospitalized patients with serious illness (1) was applied to the adult population at an academic medical center during one week in September 2021. Each patient's primary provider and bedside nurse were asked to respond to a scripted phone survey about their patient's PC needs. Data analysis was performed to compare Results: from the primary provider and nurse surveys, and both were compared against a novel EMR-based screening algorithm to identify PC needs (discussed in a separate abstract). Results During the survey week, a total of 268 patients were identified as having serious illness, and at least one clinician was surveyed for 224 of these patients (83.6%). Seventeen patients (7.6%) were followed by the inpatient PC consult team at the time. Providers reported that 60 patients (27%) had an unmet PC need. Sixty patients (27%) were reported as having intolerable and/or uncontrolled physical symptoms, with pain being most common. Primary providers reported that 96 patients and/or their caregivers (43%) were experiencing non-physical suffering. Primary providers were concerned that their patient might die during this hospitalization in 16% of cases. Conclusion According to a survey of PC needs, over a quarter of seriously ill patients had an unmet PC need, representing approximately 11% of the total hospitalized population. Only a small percentage of patients with physical or psychosocial distress were receiving subspecialty PC services, demonstrating an opportunity for service expansion. Keywords Models of Palliative Care DeliveryManaging Suffering and Distress