By Debra Wood, RN, contributor
Hospital palliative care teams can enhance end-of-life care, but now a new multicenter study indicates this interdisciplinary approach to treatment of seriously ill patients with advanced illnesses can save hospitals more than $300 a day.
"We make the use of resources more appropriate and in line with the patient’s plan of care," said Lyn Ceronsky, APRN, MS, system director of Transitions and Life Choices at Fairview Health Services’ Palliative Care Leadership Center in Minneapolis, Minnesota.
Palliative care teams typically respond to referrals from the attending physician. The teams may include a physician, a nurse or nurse practitioner, a social worker, a psychologist, a chaplain and a pharmacist.
The teams organize family meetings, assist with discharge planning and manage pain, persistent nausea and other symptoms associated with the end of life.
"We are making a complete assessment of the patient’s physical condition in concert with talking with patients and families about their goals and expectations," said Sharol Herr, RN, BSN, MSEd, palliative nurse clinician and education coordinator at Mount Carmel Health System in Columbus, Ohio. "When we listen to families and are implementing a plan that’s medically aligned with their values and goals, it helps give clarity to medical management."
That approach leads to significant cost savings, even after factoring in personnel costs. Physicians and nurse practitioners can, typically, bill for their services.
The Center to Advance Palliative Care and the National Palliative Care Research Center, both national, nonprofit organizations located at Mount Sinai School of Medicine in New York City conducted the study at eight hospitals with established palliative care programs in various parts of the country. Fairview Health and Mount Carmel Health participated in the study.
Researchers compared data involving patients receiving palliative care to similar patients given usual care. They found palliative care consultations were associated with a $1,700 direct hospital cost savings for each live discharge and $5,000 per admission for patients who died. Savings resulted from significant reductions in pharmacy, laboratory and intensive care costs.
"When palliative care is involved, there is an opportunity to step back and ask if an X-ray or physical therapy appointment is connected to the patient’s goals of care at this point," Ceronsky said. "That’s where the cost savings happened, because you are changing the plan of care."
Ceronsky offered other examples, such as discontinuing a cholesterol-lowering medication and assessing the need for routine diagnostic tests when their outcome will not alter the plan of care. In addition, palliative care patients are more likely to move out of intensive care units, which decreases costs.
For an average 400-bed hospital treating 500 palliative care patients a year, palliative care services represent a net savings of $1.3 million per year. Archives of Internal Medicine published the results in the September 8, 2008, issue.
In addition to the cost benefits, prior studies have shown that palliative care programs improve symptom management, caregiver well-being and family satisfaction, the authors said.
"It feels to some patients and families that they are being cradled or supported during this journey," Ceronsky said.
The nurses find it personally rewarding to advocate for their patients and to improve quality of life while helping the patient understand all the possibilities.
"It challenges me every day in terms of critical thinking and being supportive to families," Herr said. "It’s important and imperative to care for body, mind and spirit, and this area of nursing lets me do that."