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Keywords

30-day readmission, palliative, Rothman Index, trigger

 

Authors

  1. Henderson, Rebecca Gagne MSN, APRN, ACHPN
  2. McCloskey, Barbara DNSc, RN
  3. Walter, Ellen BSN, RN
  4. Rimar, Joan DNSc, RN
  5. Bai, Mei PhD, RN
  6. Moritz, Ernest D. MD

Abstract

Despite the increased number of palliative care teams in the United States, access to palliative care in the hospital continues to be inadequate. The availability of a simple method to identify appropriate patients for palliative care may increase access. A pilot study was conducted using an observational prospective approach to analyze the effects of palliative interventions for those with a Rothman Index score of less than 40 and a length of stay of greater than 5 days for patients in the medical intensive care and step-down units in an urban teaching hospital, which provides tertiary palliative care. The Rothman Index is a validated formula providing a real-time measure of patient condition based on existing data in the electronic medical record. Patients receiving the palliative intervention had a decrease in the mean length of stay from 26.3 days for all other groups to 13.9 days. The odds ratio of a 30-day readmission for those patients without a palliative visit was 4.4. Costs were lowered by 54% for the palliative intervention group. The Rothman/length of stay trigger for palliative care intervention may have the potential to bend the cost curve for the health care system.