Ordering Palliative Care Consult by Default Increases Rate of Consultation

Jan 23, 2024

MONDAY, Jan. 22, 2024 (HealthDay News) — Ordering palliative care consultation by default increases the rate of consultation but does not reduce the length of stay for older hospitalized patients with advanced chronic illness, according to a study published in the Jan. 16 issue of the Journal of the American Medical Association.

Katherine R. Courtright, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues examined whether ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increases consultations and improves outcomes among patients aged 65 years or older with advanced chronic obstructive pulmonary disease, dementia, or kidney failure compared with usual care, which allows clinicians to choose to order palliative care.

The primary analytic sample included 24,065 patients: 10,313 in the default order group and 13,752 in the usual care group. The researchers found that the percentage of patients receiving palliative care consultation was higher in the default order group versus the usual care group (43.9 versus 16.6 percent; adjusted odds ratio, 5.17), and they received consultation earlier (mean, 3.4 versus 4.6 days after admission). There was no difference observed in the length of stay between the groups. Compared with the usual care group, patients in the default order group had higher rates of do-not-resuscitate at discharge and discharge to hospice (adjusted odds ratios, 1.40 and 1.30, respectively).

“We know that health care systems have limited resources and need more evidence to guide future scaling and delivery of inpatient palliative care in an equitable and cost-effective manner,” senior author Scott D. Halpern, M.D., Ph.D., also of the University of Pennsylvania, said in a statement. “As we build on this work, our goal is to continuously improve inpatient palliative care so that all patients and families facing a serious illness have access to the support they need to carry on with their daily lives throughout their treatment journey.”

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