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Palliative Care: Beyond End-of-Life Care

04/28/2022

By John House; Kevin Sexton, MD; Howard Corwin, MD; and Hanna Jensen, MD, PhD

Palliative care is an expanding specialty that is increasingly becoming more integrated into the care of all patients and not just those needing end-of-life care.

Surgery is a field that has historically underutilized palliative care, despite support for palliative care by the American College of Surgeons. 

It is not immediately clear based on existing literature why this gap exists and research is needed to: 

  • explore the barriers to palliative care utilization in surgical patients
  • determine the potential system-level benefits
  • improve the patient experience and patient-centered outcomes 

We believed that this particular cohort of patients, who likely have increased morbidity and mortality, might be a population that could benefit from palliative care (beyond end-of-life care). In our study, “The Impact of Palliative Medicine Consultation on Readmission Rates and Hospital Costs in Surgical Patients Requiring Prolonged Mechanical Ventilation,” from the May 2022 issue of The Joint Commission Journal on Quality and Patient Safety, we identified significant benefits resulting from palliative care utilization in surgical patients, including decreased hospital cost and hospital readmission rates. 

The reasons for the decrease in cost and readmission rates are not completely clear but may relate to the fact that there was a higher rate of discharge to intermediate and long-term care facilities when palliative care was involved. Further, those patients discharged to intermediate and long-term care facilities had a shorter hospital length of stay with palliative care involvement.  

National Readmissions Database
Our study was only possible with the National Readmissions Database (NRD). The NRD is compiled from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases which are fairly unique federal-state-industry partnerships and have a vast amount of data related to U.S. hospital admissions. The National Inpatient Sample (NIS) has been extensively used in surgical research, but not many publications utilize the NRD, which allows for tracking of hospital admissions and re-admissions across a calendar year. 

We were curious to see how helpful the NRD would be in addressing a clinically relevant question. We were delighted to see that it could be used in a meaningful fashion to extract and interpret nationwide clinical data. While it has its pitfalls, as discussed at length in the “Limitations” section of our paper, we hope this study inspires other researchers to utilize it. 

We look forward to tracking the application of palliative care across nationwide cohorts as more and more recent data becomes available. We believe future research that identifies which specific surgical populations could benefit most from the involvement of palliative care could be valuable as criteria to effectively identify these patients are currently lacking. Additionally, we hope that palliative care is integrated into daily practices in the surgical ICU – involving bedside surgical teams and palliative care teams, as well as additional resources and training for these teams. 

John House is a fourth-year medical student at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Arkansas. Kevin Sexton, MD, is an Associate Professor in the Department of Surgery at UAMS. Howard Corwin, MD, is in the Department of Internal Medicine at UAMS. Hanna Jensen, MD, PhD, is an Assistant Professor and directs clinical research in the Division of Trauma and Acute Care Surgery in the Department of Surgery at UAMS.