Introduction: Palliative care consultation (PCC) decreases patient suffering and clarifies goals of care. It also has the potential to decrease length of stay (LOS) and hospitalization costs. Recently, the American Heart Association released a statement stressing the importance of PCC in stroke patients. We sought to evaluate the usage of PCC in acute stroke patients at a comprehensive stroke center and to determine the effect of early PCC on LOS.
Methods: We reviewed the charts of acute ischemic and hemorrhagic stroke patients (n=319) with a hospital stay of ≥ 6 days admitted over a 1-year period. Student’s t-test and Fisher’s exact test were used for continuous and categorical variables, respectively.
Results: Overall, 54/319 (16.9%) patients had PCC. Mean age, mean National Institute of Health Stroke Scale, and median pre-hospital Modified Rankin Scale were 79, 19.9, and 3, respectively, for the PCC subgroup. In general, patients who did not receive PCC trended towards lower mean LOS (No PCC 9.46 days vs PCC 10.22 days; p=0.12). A statistically significant decrease in mean LOS was observed among patients with early PCC (≤3 days, n=28) versus late PCC (≥4 days, n=26; 8.71 days vs 11.85 days; p=0.02). In-hospital mortality (3.6% vs 11.5%), hospice deaths (64.2% vs 65.2%), and discharges to home or rehabilitation (32.1% vs 23.1%) were similar between groups (p=0.52).
Conclusions: Early PCC in severe stroke patients decreased hospital LOS by 3 days. This may be due to prompt clarification of goals of care and hastened discharge to hospice. Advanced age, poor pre-stroke functional status, and severe post-stroke deficits and disability warrant early PCC. In addition to decreasing LOS, further study is needed to determine whether early PCC also limits futile tests, procedures, and iatrogenic complications. Ultimately, timely identification of PCC candidates may produce higher satisfaction and decreased hospital costs.