O3228: Development and Implementation of Palliative Care “Pause” Criteria

Purpose/Objectives: Throughout palliative care (PC), sustainability and bandwidth management are significant concerns. We strive to balance meeting the PC needs of our patients and provide continuity with the burdens of increasing workloads. At a national level, criteria and best practices regarding ongoing PC engagement are needed.

PC is well established at our institution and our team consistently follows 1/4 to 1/3 of all hospitalized patients. In 2022 our PC team reached a record daily census of 97 inpatients (34.7% of total hospital census). This was unsustainable from patient care and staff burden perspectives. We developed and implemented consensus criteria for a "Pause", allowing PC to remain engaged peripherally for hospitalized patients without active PC needs.

Design/Methods: The PC team performed a lean A3 to identify issues impeding our ability to meet patient needs while maintaining the "essence" of palliative care and integrity in our work and ourselves. The A3 team identified that some inpatients followed by our team no longer had active PC needs, but did not meet our pre-defined discharge criteria.

We worked with key stakeholders from teams that frequently consult PC to develop consensus criteria for the PC Pause to allow PC to remain engaged peripherally without actively following patients on a daily basis. We worked with IT and developed a EMR workflow. After a 90-day trial we evaluated the number of Pauses and reviewed these patient charts to ensure that no significant medical events were missed or palliative care needs unmet. We have continued to evaluate and optimize the PC Pause, including the development of “Pause patrol” in which one team member reviews our current inpatient census weekly to assess if there are active patients that merit a Pause. Quarterly review of paused patients is ongoing as well.

Results: In the first 9 months of this initiative, we have placed 67 PC Pauses. The number of Pauses per quarter has increased from 13 to 29 in the most recent quarter. The average daily percentage of total hospitalized patients followed by PC has decreased from 24.6% to 21% over the same time period. There have been no major medical events or “misses” on paused patients. Consensus among the PC team is that this initiative has positively impacted the workload burden.

Conclusion/Discussion: Thus far the PC Pause has demonstrated a reduction in workload burden without negative impact on patient care. This effort allows PC providers to focus on acute needs and the “essence” of PC without compromising the continuity and long-term relationships that are hallmarks of this specialty. Next steps include expansion of Pause criteria and additional data analysis. We will also survey consulting teams and families about the impact of the PC Pause on their care experience.