Key result
Implementing referral guidelines and point-of-care education increases new HF palliative care consults to 28%.
Why the study?
Integrating palliative care with heart failure management improves quality of life and preparedness planning, but palliative care was utilized in only 6.5% of heart failure admissions at a Veterans Affairs hospital.
Does a quality improvement initiative involving referral guidelines and point-of-care education increase palliative care referrals in patients admitted with heart failure?
Does a quality improvement initiative involving referral guidelines and point-of-care education increase palliative care referrals in patients admitted with heart failure?
Absolute Event Rate: 28% vs 6.5%
A quality improvement initiative utilizing point-of-care education and referral guidelines significantly increased palliative care referrals for patients hospitalized with heart failure.
May enhance palliative care access in HF admissions; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVES: Heart failure (HF) portends significant morbidity and mortality. Integrating palliative care (PC) with HF management improves quality of life and preparedness planning. At a Veterans Affairs hospital, PC was used in 6.5% of patients admitted for HF from October 2019 to September 2020. We sought to increase the percentage of referrals to PC to 20%. METHODS: PC referral guidelines were developed and used to screen all HF admissions between October 2020 and May 2021. Point-of-care education on the benefits of PC was delivered to teams caring for patients who met PC referral criteria. Changes were tested using Plan-Do-Study-Act (PDSA) cycles. Results were analysed using run charts. RESULTS: During the study period, there were 109 HF admissions in patients who were not already followed by PC. Thirty-one (28%) received a new PC consult. The mean age was 81±9.5 years, median B-type natriuretic peptide was 1202 pg/mL, and mean length of stay was 8±5 days. After our intervention, there was an upward shift in the percentage of new referrals to PC with 6 values above the baseline median, which represents a significant change. CONCLUSIONS: Through multiple PDSA cycles, referrals to PC for patients admitted with HF increased from 6.5% to 28%. Point-of-care education was an effective tool to teach medical teams about the benefits of PC. Inpatient teams more consistently and independently considered PC for patients with HF, representing a cultural shift. This quality improvement model may serve as a paradigm to improve the care of HF patients.
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Gruen et al. (2023) studied Heart failure (n=109). Palliative care referral guidelines and point-of-care education vs. Historical baseline was evaluated on New palliative care consults. Implementation of palliative care referral guidelines and point-of-care education increased new palliative care consults for heart failure admissions from 6.5% to 28%.
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