Empirically-Derived Criteria for Referral of Burn Patients to Palliative Care

1. Name 4 areas of palliative care service provided to burn patients and families 2. Name at least 5 criteria for which to consult specialist palliative care Burns often require complex interdisciplinary care. Specialist palliative care (PC) minimizes suffering, aids in decision making, and provides...

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Published in:Journal of pain and symptom management 2022-05, Vol.63 (5), p.882-882
Main Authors: Grossoehme, Daniel, Friebert, Sarah, Shaner, Valerie, Teo, Esther, Brown, Carrie, Eickmeyer, Shari, Khandelwal, Anjay, Lou, Richard
Format: Article
Language:English
Subjects:
Bereavement
Burns
Complex patients
Decision making
End of life decisions
Family support
Interdisciplinary aspects
Medical referrals
Objectives
Palliative care
Pediatrics
Psychosocial factors
Qualitative research
Symptom management
Teams
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Summary:1. Name 4 areas of palliative care service provided to burn patients and families 2. Name at least 5 criteria for which to consult specialist palliative care Burns often require complex interdisciplinary care. Specialist palliative care (PC) minimizes suffering, aids in decision making, and provides family support in addition to end-of-life (EOL) care. Specialist PC is a limited resource, best conserved by identifying patients most likely to benefit from a PC referral. Little guidance is available for clinicians on whether and when to refer to PC. Identify referral criteria via a mixed-methods approach in our burn center serving adult and pediatric patients. 5-year retrospective review of a matched cohort of patients with and without PC consultation. Qualitative analysis of PC consultation notes was performed to identify indication and services provided. Draft criteria were reviewed by an expert panel. 35 patients had PC consultations; 330 patients were eligible as controls. Propensity scoring found 22 matched pairs; between-group demographics were similar. Average time to PC consultation was 214 hours; mean time from consultation to death was 166 hours. Four themes for consultation were identified: physical symptom management, establishing goals of care, EOL care, and psychosocial management. Consultation criteria identified were EOL anticipated within 7 days, goals of care unarticulated or conflicted, specialist bereavement care indicated, prolonged functional loss, ventilated over 7 days, SCORTEN ≥4, and Baux score ≥ 100. Criteria to prompt consideration for consultation were also identified. PC consultation indications extended well beyond EOL or goals of care. We propose referral criteria for consultation and consideration and will subsequently examine adherence to and outcomes for improvement. As the scope of PC continues to evolve, indications for consultation must balance increasing access with overwhelming capacity. Early PC consultation may be of benefit to adult and pediatric burn patients. Collaboration between PC and burn teams can improve the value proposition for PC and the multidisciplinary approach in complex patients.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2022.02.082