Original Article
Palliative Care Consultation Versus Palliative Care Unit: Which Is Associated With Shorter Terminal Hospitalization Length of Stay Among Patients With Cancer?
American Journal of Hospice & Palliative Medicine® 2015, Vol. 32(3) 275-279 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909113514476 ajhpm.sagepub.com
Samy A. Alsirafy, MBBCh, MSc, MD, DipPallMed1, Ahmad M. Abou-Alia, MBBCh, MSc2, and Hafez M. Ghanem, MBBCh, MSc, MD2
Abstract Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [+9.4] vs 17.8 [+19.7] days, respectively; P < .001). Direct terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service. Keywords palliative care unit, palliative care consultation, length of stay, end-of-life care, advanced cancer, tertiary care hospital
Introduction 1
Worldwide, millions die of cancer each year. In spite of the ongoing efforts to improve end-of-life (EoL) care for these dying patients, the current evidence shows that a significant proportion of them receive unnecessary aggressive EoL care and that this aggressiveness is increasing.2,3 In order to assess the aggressiveness of EoL care for patients dying of cancer, some quality indicators based on administrative nonclinical data have been suggested. These indicators included, for example, admission to intensive care units, visiting the emergency department, and lengthy hospitalization at the EoL.4 In addition to its possible value in assessing EoL care aggressiveness, hospital length of stay (LoS) is frequently used to assess the efficiency of health care systems.5,6 With the spread of hospital-based palliative care (PC) programs, it was important to determine their impact on hospital LoS.7 A number of studies investigated the relation between hospital LoS and different hospital-based PC models like palliative care consultation (PCC) services7-10 and inpatient palliative care units (PCUs).11-13 These studies provided conflicting evidence and, to the best of our knowledge, there was no head-to-head comparison between PCC and PCU models regarding their impact on the LoS.
In Saudi Arabia, PC is in an early stage of development and is represented by relatively few hospital-based PC programs including PCUs.14,15 In the absence of subacute stand-alone PC models in Saudi Arabia, PCUs are expected to look after terminally ill patients with cancer for whom subacute models may be more suitable. This special situation may raise a concern among hospital administrators that establishing hospital-based PCUs may have a negative impact on the LoS. Consequently, this may lead to lack of support to PCUs establishment, believing that PCC services are enough, which may not always be true.16
1
Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt 2 Palliative Care Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia Corresponding Author: Samy A. Alsirafy, MBBCh, MSc, MD, DipPallMed, Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, PO Box 99, Manial El-Roda, Cairo 11553, Egypt. Email: [email protected]
Downloaded from ajh.sagepub.com by guest on November 16, 2015
American Journal of Hospice & Palliative Medicine® 32(3)
276 This report describes the LoS of terminal hospitalization among in-hospital cancer deaths managed by a hospital-based PC program comprising a PCC service and an inpatient PCU.
Table 1. Characteristics of 328 In-Hospital Cancer Deaths. Characteristic
Group
Age group, years
Palliative Care Consultation Versus Palliative Care Unit: Which Is Associated With Shorter Terminal Hospitalization Length of Stay Among Patients With Cancer?
American Journal of Hospice & Palliative Medicine® 2015, Vol. 32(3) 275-279 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909113514476 ajhpm.sagepub.com
Samy A. Alsirafy, MBBCh, MSc, MD, DipPallMed1, Ahmad M. Abou-Alia, MBBCh, MSc2, and Hafez M. Ghanem, MBBCh, MSc, MD2
Abstract Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [+9.4] vs 17.8 [+19.7] days, respectively; P < .001). Direct terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service. Keywords palliative care unit, palliative care consultation, length of stay, end-of-life care, advanced cancer, tertiary care hospital
Introduction 1
Worldwide, millions die of cancer each year. In spite of the ongoing efforts to improve end-of-life (EoL) care for these dying patients, the current evidence shows that a significant proportion of them receive unnecessary aggressive EoL care and that this aggressiveness is increasing.2,3 In order to assess the aggressiveness of EoL care for patients dying of cancer, some quality indicators based on administrative nonclinical data have been suggested. These indicators included, for example, admission to intensive care units, visiting the emergency department, and lengthy hospitalization at the EoL.4 In addition to its possible value in assessing EoL care aggressiveness, hospital length of stay (LoS) is frequently used to assess the efficiency of health care systems.5,6 With the spread of hospital-based palliative care (PC) programs, it was important to determine their impact on hospital LoS.7 A number of studies investigated the relation between hospital LoS and different hospital-based PC models like palliative care consultation (PCC) services7-10 and inpatient palliative care units (PCUs).11-13 These studies provided conflicting evidence and, to the best of our knowledge, there was no head-to-head comparison between PCC and PCU models regarding their impact on the LoS.
In Saudi Arabia, PC is in an early stage of development and is represented by relatively few hospital-based PC programs including PCUs.14,15 In the absence of subacute stand-alone PC models in Saudi Arabia, PCUs are expected to look after terminally ill patients with cancer for whom subacute models may be more suitable. This special situation may raise a concern among hospital administrators that establishing hospital-based PCUs may have a negative impact on the LoS. Consequently, this may lead to lack of support to PCUs establishment, believing that PCC services are enough, which may not always be true.16
1
Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt 2 Palliative Care Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia Corresponding Author: Samy A. Alsirafy, MBBCh, MSc, MD, DipPallMed, Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, PO Box 99, Manial El-Roda, Cairo 11553, Egypt. Email: [email protected]
Downloaded from ajh.sagepub.com by guest on November 16, 2015
American Journal of Hospice & Palliative Medicine® 32(3)
276 This report describes the LoS of terminal hospitalization among in-hospital cancer deaths managed by a hospital-based PC program comprising a PCC service and an inpatient PCU.
Table 1. Characteristics of 328 In-Hospital Cancer Deaths. Characteristic
Group
Age group, years
