title: Education and referral criteria: impact on oncology referrals to palliative care.
abstract: OBJECTIVE
  To describe a quality improvement project involving education and referral criteria to influence oncology provider referrals to a palliative care service.
  
  
  METHODS
  A single group post-test only quasi-experimental design was used to evaluate palliative care service (PCS) referrals following an intervention consisting of a didactic presentation, education outreach visits (EOV) to key providers, and referral criteria. Data on patient demographics, cancer types, consult volume, reasons for referral, pre-consult length of stay, overall hospital stay, and discharge disposition were collected pre-intervention, then post-intervention for 7.5 months and compared.
  
  
  METHODS
  Attending oncologists, nurse practitioner, and house staff from the solid tumor division at a 700-bed urban teaching hospital participated in the project. Two geriatricians, a palliative care nurse practitioner, and rotating geriatric fellows staffed the PCS.
  
  
  RESULTS
  The percentage of oncology referrals to PCS increased significantly following the intervention (χ(2) = 6.108, p = .013). 24.9% (390) patients were referred in the 4.6 years pre-intervention and 31.5% (106) patients were referred during 7.5 months post-intervention. The proportion of consults for pain management was significantly greater post-intervention (χ(2) = 5.378, p = .02), compared to pre-intervention, when most referrals were related to end-of-life issues. Lung, pancreatic, and colon were the most common cancer types at both periods, and there were no significant differences in patient demographics, pre-referral length of hospitalization or overall hospital days. There was a trend toward more patients being discharged alive following the intervention.
  
  
  CONCLUSIONS
  A quality improvement project supported the use of education and referral criteria to influence both the frequency and reasons for palliative care referral by oncology providers.
authors.affiliation: Palliative Care Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Barbara.Reville@uphs.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Reville
authors.forename: JoAnne
authors.initials: J
authors.lastname: Reifsnyder
authors.forename: Deborah B
authors.initials: DB
authors.lastname: McGuire
authors.forename: Karen
authors.initials: K
authors.lastname: Kaiser
authors.forename: Abbie J
authors.initials: AJ
authors.lastname: Santana
mesh_terms: D032722:Advance Care Planning; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D006784:Hospitals, Teaching; D006801:Humans; D008495:Medical Oncology / Q000193:education* / Q000639:trends; D009859:Oncology Nursing / Q000193:education* / Q000639:trends; D016522:Oncology Service, Hospital / Q000592:standards* / Q000639:trends; D059408:Pain Management; D010166:Palliative Care / Q000592:standards* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D013727:Terminal Care / Q000592:standards / Q000639:trends; D000078329:Workforce