Implementing a Trigger-Based Model for Early Palliative Care Consultation on a Medical Oncology Floor

Background: A systematic review by Wendlandt et al. (2012) showed that 84% of the providers referred their patient to palliative care (PC) at a very late stage for uncontrolled symptom management. Significant barriers included a lack of training, lack of recognized referral criteria, lack of a referral protocol. A delayed PC referral can result in prolonging patient suffering from symptom distress, avoidable laboratory work in addition to unnecessary aggressive medical treatment. Purpose of Project: This Evidence-based Practice pilot project is aimed to facilitate an early PC consultation on an oncology medicine floor by implementing a Palliative care (PC) consultation screening tool to shorten admission to initial PC consultation, relieve cancer-related symptom intensity, and decrease the length of stay. EBP Intervention: 1. Adopted PC consult indications from National Comprehensive Cancer Network (NCCN) 2016 guideline to formulate a PC consult triggers. 2. Provide education of Trigger-Based Model PC consultation to floor nurses and hospitalists.3. Embedded PC consultation trigger to daily interdisciplinary team rounding. Outcome: Cancer-related symptom intensity decreases by 50%, admission to initial PC consult decrease by one day. Decrease length of stay. (Data is pending) Implication or Clinical Practice /conclusions: PC checklist adopted by NCCN guideline is a standard tool for providers and nurses when considering early PC consult initiation for oncological patients. The impact of this project yields a shorter time to PC consult; furthermore, the patient outcome on cancer-related symptom intensity also improve after a timely PC intervention