Partnership Between Medical Oncologists and Palliative Care Specialists Improves Outcomes at an Inpatient Oncology Unit
First evaluation of a pioneering “co-rounding” partnership between medical oncologists and palliative care specialists at Duke University Medical Center shows improvements in both health system–related and patient-related outcomes. The first year of the new partnership—set in the hospital’s inpatient solid tumor oncology unit—brought statistically significant decreases in average length of hospital stay and hospital readmission rates, compared to a previous year in which the partnership did not exist. There were also decreased intensive care unit (ICU) transfers, and a trend toward increased hospice referrals. The findings, to be reported at the 2014 Palliative Care in Oncology Symposium in Boston, show that this new model is both feasible and beneficial (Abstract 3).
New Co-Rounding Model
“We’ve successfully partnered with our palliative care colleagues to bring their unique skill set to our hospitalized oncology patients on a daily basis, and we’re seeing it’s a partnership worth keeping. To our knowledge, this is the first example where palliative care physicians and medical oncologists are working side by side every day on an inpatient oncology ward,” said lead study author Richard Riedel, MD, an Associate Professor of Medicine and Medical Director of the inpatient solid tumor service at Duke University Medical Center in Durham, North Carolina.
“Leveraging the skill set of both palliative care physicians and medical oncologists has allowed us to better manage symptoms, shorten hospital stays, and prevent readmissions. We’ve also been able to dispel any misconceptions that individuals may have had about the role of palliative care, and we’ve shown that nursing and physician impressions of palliative care, as a whole, are very favorable,” he said.
The “co-rounding” partnership on the medical oncology inpatient unit was designed in collaboration with Anthony Galanos, MD, Medical Director of Inpatient Palliative Care at Duke University Medical Center, and senior author for the study. The model was initiated as an intervention in 2011. Critical to the model’s success is open communication and collaboration which is fostered by formal meetings three times a day in which members of the team, including both the attending medical oncologist and the attending palliative care physician discuss all patients that are cared for in the unit.
Depending on each patient’s needs, a determination would be made as to which attending physician would oversee direct care for the patient. For example, patients with higher symptom burden would typically be assigned to the palliative care specialists. The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and the model allows for both formal and informal consultation between specialties for patients.
Study Details
Researchers assessed outcomes among the 731 patients admitted during a time period before the intervention and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
Compared to the period before the intervention, the new partnership was associated with a statistically significant decrease in average length of stay in the hospital (4.17 vs 4.51 days), as well as a 15% relative reduction in 7-day readmission rates and a 23% relative reduction in 30-day readmission rates. There were decreased ICU transfers and a trend for higher hospice referrals following the intervention, but those effects were not statistically significant. Doctors and nurses were universally satisfied with the new model.
Researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
For full disclosures of the study authors, view the study abstract at abstract.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
