title: Types and rate of implementation of palliative care team recommendations for care of hospitalized veterans.
abstract: BACKGROUND
  Hospital-based interdisciplinary palliative care teams (PCTs) are increasingly being established to meet the growing demand for high quality care for patients with life-limiting illnesses in which the goal is comfort rather than cure. Two recent studies suggest that PCTs teams are highly effective in influencing care of patients within large academic medical centers. The current study examines whether the previously demonstrated success of palliative care teams within subspecialty academic health centers could be replicated in an urban Veterans Affairs medical center (VAMC).
  
  
  OBJECTIVE
  To describe the characteristics of patients referred to, recommendations made by, and implementation rate of an interdisciplinary PCT in an urban VAMC.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  One hundred patients referred by inpatient doctor to the PCT between October 1999 and March 2002 in a 214-bed VA hospital in the New York City area.
  
  
  METHODS
  Patient demographics, prevalence of five types of recommendations by the PCT and implementation rate by primary physician: (1) advance directives; (2) discharge planning; (3) pain management; (4) symptom management of dyspnea, delirium, constipation, nausea, anxiety, and depression; and (5) consultation orders for other services.
  
  
  RESULTS
  The average number of recommendations per patient was 2.84 and 84.2% were implemented. The most frequent recommendations concerned discharge plans. The reasons recommendations were not implemented included: (1) patient or family refusal noted in the medical record, (2) the patient's clinical status changed, including patient death, and (3) the attending physician chose a different dose, medication, or route of administration than was recommended.
  
  
  CONCLUSIONS
  Overall, most recommendations were implemented by the referring physicians. This finding is consistent with several prior studies demonstrating that PCTs in acute care can and do influence processes of care for hospitalized patients. Well-designed observational studies and randomized controlled trials of specific palliative care interventions and their effect on patient, family, and health care system outcomes are needed.
authors.affiliation: The Bronx/NY Harbor Geriatric Research, Education, and Clinical Center, The Bronx VA Medical Center, New York, New York, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chong
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Olson
authors.forename: Tobe E
authors.initials: TE
authors.lastname: Banc
authors.forename: Susan
authors.initials: S
authors.lastname: Cohen
authors.forename: Robyn
authors.initials: R
authors.lastname: Anderson-Malico
authors.forename: Joan D
authors.initials: JD
authors.lastname: Penrod
mesh_terms: D000046:Academic Medical Centers; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D059408:Pain Management; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team; D010351:Patient Discharge; D012017:Referral and Consultation; D012189:Retrospective Studies