title: Utilization of palliative care consultation service by surgical services.
abstract: BACKGROUND
  Palliative medicine was recognized as a unique medical specialty in 2006. Since that time, the number of hospital-based palliative care services has increased dramatically. It is unclear how palliative care consultation services (PCCS) are utilized by surgical services. The purpose of this study was to examine utilization of PCCS by surgical services compared to medical services at the University of New Mexico.
  
  
  METHODS
  A database of palliative care consultations performed at University of New Mexico Hospital between 2009 and 2013 was queried to identify consultations requested by surgical vs. medical services. Demographic, clinical, and outcome variables were compared.
  
  
  RESULTS
  A total of 521 consultations were analyzed: 441 (85%) consultations from medical and 80 (15%) consultations from surgical services. Surgical patients were older than medical patients and more likely to be in an intensive care unit (ICU) at the time of consultation. There was no difference between referring services in indication for palliative care consultation or time from hospital admission to consultation. Surgical patients were more likely to die in the hospital compared to medical patients. Among patients discharged from the hospital alive, there was no difference between the groups in discharge disposition. More patients in both groups had a change from full code to do-not-resuscitate (DNR) status following palliative care consultation.
  
  
  CONCLUSIONS
  Referrals for palliative care consultations are much less common from surgical than medical services. Characteristics of surgical patients suggest that palliative care consultations are reserved for older patients, critically ill patients, and those more likely to be at end-of-life. Our findings suggest the possible need for increased palliative care consultations among less critically ill patients and/or those with an improved prospect of recovery.
authors.affiliation: Divison of Surgical Oncology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: Division of Palliative Care, Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Marr
authors.affiliation: Divison of Surgical Oncology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Rajput
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of New Mexico, MSC 07 4025, Albuquerque, NM 87131-001, USA. BFahy@salud.unm.edu.
authors.forename: Bridget N
authors.initials: BN
authors.lastname: Fahy
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009516:New Mexico / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000379:methods
keywords: Palliative care; surgical service; utilization