Implementing Routine Palliative Care Consultation Before LVAD Implantation

A Single Center Experience

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Context: Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service. Objective: To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. Methods: This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from January 2015 to September 2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. Results: Fifty one patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35% to 71% as workflows improved with institutional commitment. Symptom assessment, psychosocial assessment, and advance care planning (ACP) were always performed (n = 28; 100%). More than half of the patients were evaluated for dyspnea (n = 20; 71%), fatigue (n = 18; 64%), and pain (n = 16; 57%). Consults centered around ACP, and very few patients (n = 7; 25%) required palliative care follow-up. Palliative consultation did not delay LVAD placement. Conclusion: Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.

Original languageEnglish (US)
JournalJournal of Pain and Symptom Management
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Heart-Assist Devices
Palliative Care
Referral and Consultation
Advance Care Planning
Workflow
Patient Care
Symptom Assessment
Consultants
Dyspnea
Fatigue
Blood Vessels
Heart Failure
Joints
Quality of Life
Pain

Keywords

  • advance care planning
  • advanced cardiac therapies
  • health services
  • heart failure
  • Left ventricular assist device
  • palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{0d097bccc4684a0f926332dfda98e4a8,
title = "Implementing Routine Palliative Care Consultation Before LVAD Implantation: A Single Center Experience",
abstract = "Context: Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service. Objective: To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. Methods: This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from January 2015 to September 2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. Results: Fifty one patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35{\%} to 71{\%} as workflows improved with institutional commitment. Symptom assessment, psychosocial assessment, and advance care planning (ACP) were always performed (n = 28; 100{\%}). More than half of the patients were evaluated for dyspnea (n = 20; 71{\%}), fatigue (n = 18; 64{\%}), and pain (n = 16; 57{\%}). Consults centered around ACP, and very few patients (n = 7; 25{\%}) required palliative care follow-up. Palliative consultation did not delay LVAD placement. Conclusion: Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.",
keywords = "advance care planning, advanced cardiac therapies, health services, heart failure, Left ventricular assist device, palliative care",
author = "Say Salomon and Hilary Frankel and Chuang, {Elizabeth J.} and Serife Eti and Selwyn, {Peter A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpainsymman.2017.12.490",
language = "English (US)",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Implementing Routine Palliative Care Consultation Before LVAD Implantation

T2 - A Single Center Experience

AU - Salomon, Say

AU - Frankel, Hilary

AU - Chuang, Elizabeth J.

AU - Eti, Serife

AU - Selwyn, Peter A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Context: Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service. Objective: To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. Methods: This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from January 2015 to September 2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. Results: Fifty one patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35% to 71% as workflows improved with institutional commitment. Symptom assessment, psychosocial assessment, and advance care planning (ACP) were always performed (n = 28; 100%). More than half of the patients were evaluated for dyspnea (n = 20; 71%), fatigue (n = 18; 64%), and pain (n = 16; 57%). Consults centered around ACP, and very few patients (n = 7; 25%) required palliative care follow-up. Palliative consultation did not delay LVAD placement. Conclusion: Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.

AB - Context: Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service. Objective: To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. Methods: This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from January 2015 to September 2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. Results: Fifty one patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35% to 71% as workflows improved with institutional commitment. Symptom assessment, psychosocial assessment, and advance care planning (ACP) were always performed (n = 28; 100%). More than half of the patients were evaluated for dyspnea (n = 20; 71%), fatigue (n = 18; 64%), and pain (n = 16; 57%). Consults centered around ACP, and very few patients (n = 7; 25%) required palliative care follow-up. Palliative consultation did not delay LVAD placement. Conclusion: Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.

KW - advance care planning

KW - advanced cardiac therapies

KW - health services

KW - heart failure

KW - Left ventricular assist device

KW - palliative care

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