Using the Rothman Index and Length of Stay as a Trigger for Palliative Care in the Medical Intensive Care Unit and Step-Down Units

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Abstract

Despite the increased number of palliative care teams in the United States, access to palliative care in the hospital continues to be inadequate. The availability of a simple method to identify appropriate patients for palliative care may increase access. A pilot study was conducted using an observational prospective approach to analyze the effects of palliative interventions for those with a Rothman Index score of less than 40 and a length of stay of greater than 5 days for patients in the medical intensive care and step-down units in an urban teaching hospital, which provides tertiary palliative care. The Rothman Index is a validated formula providing a real-time measure of patient condition based on existing data in the electronic medical record. Patients receiving the palliative intervention had a decrease in the mean length of stay from 26.3 days for all other groups to 13.9 days. The odds ratio of a 30-day readmission for those patients without a palliative visit was 4.4. Costs were lowered by 54% for the palliative intervention group. The Rothman/length of stay trigger for palliative care intervention may have the potential to bend the cost curve for the health care system.

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