title: Development and implementation of a palliative care consultation tool.
abstract: OBJECTIVE
  Palliative care services are becoming more commonplace in hospitals and have the potential to reduce hospital costs through length of stay reduction and remediation of symptoms. However, there has been little systematic attempt to identify when a palliative care consultation should be triggered in a hospital, and there is some evidence that these services are under-utilized and not fully understood.
  
  
  METHODS
  In an initial attempt to address when a consultation might be appropriate, we attempted to pilot test a novel palliative care screening tool to help guide clinician judgment in this regard. A one-page, face-valid instrument was developed using expert opinion.
  
  
  RESULTS
  The sample comprised 33 men (44.6%) and 41 women (55.4%) with an average age of 63.4 years (SD = 13.8) and an average length of stay of 22.7 days (SD = 10.1). The most significant symptom was pain, indicated as moderate-to-severe in 23 patients (31%). This was followed by fatigue (n = 10, 13.5%) and nausea (n = 6, 8.1%). At unit entry, 20 patients (33%) had moderate or severe pain. Upon discharge, this number had been reduced to 12/60 (20%). Chi-Square analysis showed a significant decrease in pain rankings overall (χ2 = 36.3, p < 0.0001). The average total tool score was 7.5 (SD = 3.1). Using an initial threshold of 12 to trigger a palliative care referral, 64 patients (86.5%) would not have received a referral and 10 (13.5%) would have. Of these 10 patients, 2 (20%) did not receive a palliative care consultation while they were hospitalized.
  
  
  CONCLUSIONS
  The tool we developed increased consultations over the time period in which it was used, compared with the same time period 1 year prior. Although the threshold developed for triggering referrals seemed artificially high, the implementation of the screening tool did increase referrals.
authors.affiliation: St. Joseph's Hospital, Continuing Care Hospital, Lexington, Kentucky 40503, USA.
authors.forename: Alexei
authors.initials: A
authors.lastname: Trout
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Kirsh
authors.forename: John F
authors.initials: JF
authors.lastname: Peppin
mesh_terms: D000208:Acute Disease; D003657:Decision Making; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007629:Kentucky; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008134:Long-Term Care / Q000191:economics / Q000639:trends; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D059408:Pain Management; D010166:Palliative Care / Q000191:economics / Q000592:standards* / Q000639:trends; D010865:Pilot Projects; D011368:Professional-Family Relations; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics / Q000592:standards* / Q000639:trends; D012047:Rehabilitation Centers / Q000191:economics / Q000639:trends; D062606:Tertiary Care Centers / Q000191:economics / Q000592:standards* / Q000639:trends; D013997:Time Factors