Palliative Care Utilization and Advance Care Planning in End-Stage Liver Disease: A Quality Improvement Project

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Identifier 2019_Freudenberg
Title Palliative Care Utilization and Advance Care Planning in End-Stage Liver Disease: A Quality Improvement Project
Creator Freudenberg, Anna
Subject Advanced Practice Nursing; Education, Nursing, Graduate; End Stage Liver Disease; Palliative Care; Health Care Costs; Patient Admission; Mortality; Electronic Health Records; Advance Care Planning; Severity of Illness Index; Quality of Life; Quality Improvement
Description Problem: Patients with end-stage liver disease (ESLD) have high mortality, symptom burden, and healthcare utilization. Palliative care and advance care planning support patients' healthcare goals, improve quality of life, and decrease healthcare costs; however, utilization of these services are often infrequent. In this project, data were collected and analyzed from a single academic medical center regarding palliative care utilization and advance care planning that provides evidence to stakeholders supporting the need for practice change and quality improvement for patients with ESLD at this institution. Methods: A retrospective review of electronic health records (EHR) was performed to examine patients with ESLD with at least one inpatient admission to the study hospital. Data were collected on patients beginning at their index admission on or after October 1, 2015, until their death date or December 31, 2017. Two presentations were delivered to the hospital palliative care team, both pre-and post-data collection, to disseminate findings and recommendations. Results: Of the 530 patients identified, 32.6% died during the study period with 68.8% dying as inpatients at the study hospital. Only 15.5% received a palliative care consult, and 37.5% had advance directives charted in EHR. Almost 66% had at least one ICU admission, and about 18% were deferred, ineligible, removed, or inactive from the liver transplant list. These findings were presented to the palliative care team, who expressed support for a future quality improvement project. Conclusion: The findings reveal that inpatient mortality and healthcare utilization are high, and palliative care utilization and advance care planning are underutilized for patients with ESLD at this institution. The evidence collected, analyzed, and presented proved to be an impetus for future practice change.
Relation is Part of Graduate Nursing Project, Doctor of Nursing Practice, DNP
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019
Type Text
Rights
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Language eng
ARK ark:/87278/s6tt97gt
Setname ehsl_gradnu
ID 1428549
Reference URL https://collections.lib.utah.edu/ark:/87278/s6tt97gt
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