Authors
- Sivakumar Subramaniam1,
- Sivakumar Subramaniam2,
- Annette Cudmore1,
- Annette Cudmore2
- Goulburn Valley Health1,
- West Hume Palliative Care2
2018
Excerpt
Background:
There are number of patients coded as Palliative care episode during their Hospital stay. Hospitals which provide specialist palliative care services will have a higher number of patients admitted specifically for palliative care than found in the normal mix of admitted patients. A higher number of palliative patient admissions could skew a mortality measure for a Hospital. To address this concern, the calculation of risk of death in the HSMR adjusts for patients receiving palliative care.The increase in palliative coding across time could be due to a number of factors. These include; An increase in the number of patients receiving palliative care , Improvements to the clinical coding of patients receiving palliative care,Changes in the interpretation of guidelines around coding of palliative care.
Aim:
This retrospective clinical audit was carried out to assess appropriateness of usage of Palliative care code in our regional Hospital. We selected September, October 2017 (two months period) for data collection.
Method:
Data was collected for diagnosis (terminal or non- terminal diagnosis), Number of days since admission to be coded as palliative, reason for coding palliative, number of days on palliative care code, outcome of the admission, wards where the patient was based.
A palliative patient is someone who has had a diagnosis of a life limiting illness and who is receiving treatment to relieve symptoms related to their condition.
Ethics: approval obtained from Hospital ethics committee.
Results:
• 37 patients were coded as palliative during the two months.
• Cancer patients:15; Non Cancer 22
• Dementia-11; multiple-comorbidities:14
• 14 patients were known palliative care pre-admission
• Outcome: 17 out of 37 died; Of those discharged- 8 went home, 7 to Aged care, 5 to peripheral Hospitals.
• Bed days as Code 8: 7 patients had 1 day, 1 had2 days, 4 had 3 days, 10 had 4- 7 days, 9 had 8- 14 days, 6 had more than 2 weeks.
• 10/37 was admitted directly under palliative care.
• 7 taken over by palliative care team.
• In total 24/37 was known to Hospital palliative care team.
Deaths:
• 17 of the 37 patients coded as code palliative patient died in the Hospital.
• 7 under palliative care; 10 under other teams
Total Deaths during that time: 45
17/45 were coded as palliative (28/45 were not coded as code palliative).
Conclusion:
All the patients coded as Palliative were appropriate – No misuse of code (those had terminal diagnosis/likely to die in the next 12 months). Interestingly, 28 of those 45 who died during the 2 months – not coded as palliative. 66.6% of patients who died were not coded as palliative.This shows under usage, rather than over usage of palliative code. This prompted need for further audit by checking those cases. Further analysis showed about 7 of 28 patients could have been coded as palliative. We identified various reasons for not coding the other 21 patients.
Discussion:
This audit confirmed the lack of documentation or late recognition of dying patients in acute Hospital setting. Further measures are implemented in our Hospital to improve this identified issue.
There are number of patients coded as Palliative care episode during their Hospital stay. Hospitals which provide specialist palliative care services will have a higher number of patients admitted specifically for palliative care than found in the normal mix of admitted patients. A higher number of palliative patient admissions could skew a mortality measure for a Hospital. To address this concern, the calculation of risk of death in the HSMR adjusts for patients receiving palliative care.The increase in palliative coding across time could be due to a number of factors. These include; An increase in the number of patients receiving palliative care , Improvements to the clinical coding of patients receiving palliative care,Changes in the interpretation of guidelines around coding of palliative care.
Aim:
This retrospective clinical audit was carried out to assess appropriateness of usage of Palliative care code in our regional Hospital. We selected September, October 2017 (two months period) for data collection.
Method:
Data was collected for diagnosis (terminal or non- terminal diagnosis), Number of days since admission to be coded as palliative, reason for coding palliative, number of days on palliative care code, outcome of the admission, wards where the patient was based.
A palliative patient is someone who has had a diagnosis of a life limiting illness and who is receiving treatment to relieve symptoms related to their condition.
Ethics: approval obtained from Hospital ethics committee.
Results:
• 37 patients were coded as palliative during the two months.
• Cancer patients:15; Non Cancer 22
• Dementia-11; multiple-comorbidities:14
• 14 patients were known palliative care pre-admission
• Outcome: 17 out of 37 died; Of those discharged- 8 went home, 7 to Aged care, 5 to peripheral Hospitals.
• Bed days as Code 8: 7 patients had 1 day, 1 had2 days, 4 had 3 days, 10 had 4- 7 days, 9 had 8- 14 days, 6 had more than 2 weeks.
• 10/37 was admitted directly under palliative care.
• 7 taken over by palliative care team.
• In total 24/37 was known to Hospital palliative care team.
Deaths:
• 17 of the 37 patients coded as code palliative patient died in the Hospital.
• 7 under palliative care; 10 under other teams
Total Deaths during that time: 45
17/45 were coded as palliative (28/45 were not coded as code palliative).
Conclusion:
All the patients coded as Palliative were appropriate – No misuse of code (those had terminal diagnosis/likely to die in the next 12 months). Interestingly, 28 of those 45 who died during the 2 months – not coded as palliative. 66.6% of patients who died were not coded as palliative.This shows under usage, rather than over usage of palliative code. This prompted need for further audit by checking those cases. Further analysis showed about 7 of 28 patients could have been coded as palliative. We identified various reasons for not coding the other 21 patients.
Discussion:
This audit confirmed the lack of documentation or late recognition of dying patients in acute Hospital setting. Further measures are implemented in our Hospital to improve this identified issue.