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Chart of the Day: Default Orders Increased Palliative Care Consultations But Did Not Shorten Hospital Stays for Older Patients

Study Shows a Simple Intervention Improves End-Of-Life Care for Seriously Ill Patients

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Palliative care consultation is recommended for patients with serious illnesses, but many aren’t referred for this care or only receive a consultation at the end of their lives. To test whether a simple intervention would improve palliative care consultation rates and outcomes as measured by length of stay in the hospital, LDI Senior Fellows Katherine Courtright, Scott Halpern, Dylan Small, Mary Ersek and their team conducted a multisite randomized trial that included over 24,000 patients.

The study, published in JAMA, randomized hospitalized patients 65 years or older with serious illnesses (advanced chronic obstructive pulmonary disease [COPD], dementia, or kidney failure) to have default orders for palliative care added to their charts or usual care. Among the patients with default orders in their charts, 43.9% received a consult compared to 16.6% who did not. In addition, patients in the intervention group who received a consultation received it more quickly. While there was no significant difference (4.9 versus 5 days) in the length of stay between the two groups, the study demonstrated that a default order in patients’ charts improves end-of-life care for seriously ill patients.

The study, “Default Palliative Care Consultation for Seriously Ill Hospitalized Patients: A Pragmatic Cluster Randomized Trial,” was published on January 16, 2024 in JAMA. Authors include Katherine R. Courtright, Vanessa Madden, Brian Bayes, Marzana Chowdhury, Casey Whitman, Dylan S. Small, Michael O. Harhay, Suzanne Parra, Elizabeth Cooney-Zingman, Mary Ersek, Gabriel J. Escobar, Sarah H. Hill, and Scott D. Halpern.

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Christine Weeks

Christine Weeks

Director, Strategic Initiatives

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