TY - JOUR
T1 - Characteristics and outcomes of patients admitted to the acute palliative care unit from the emergency center
AU - Shin, Seong Hoon
AU - Hui, David
AU - Chisholm, Gary B.
AU - Kwon, Jung Hye
AU - San-Miguel, Maria Teresa
AU - Allo, Julio A.
AU - Yennurajalingam, Sriram
AU - Frisbee-Hume, Susan E.
AU - Bruera, Eduardo
N1 - Funding Information:
Dr. E. Bruera is supported in part by National Institutes of Health grants RO1NR010162-01A1 , RO1CA122292-01 , and RO1CA124481-01 . Dr. D. Hui is supported in part by an institutional start-up grant (#18075582). This study also was supported by the M. D. Anderson Cancer Center Support Grant ( CA 016672 ). The funding sources were not involved in the conduct of the study or development of the submission. The authors declare no conflicts of interest.
PY - 2014/6
Y1 - 2014/6
N2 - Context Most patients admitted to acute palliative care units (APCUs) are transferred from inpatient oncology units. We hypothesized that patients admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes that differ from those of transferred inpatients. Objectives The purpose of this retrospective cohort study was to compare the symptom burdens and survival rate of patients admitted to an APCU from an EC with those of inpatients transferred to the APCU. Methods Among the 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 inpatients transferred to the APCU as controls (The outcome data were unavailable for two patients). We retrieved data on patient demographics, cancer diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and overall survival from time of admission to the APCU. Results The EC patients had higher rates of pain, fatigue, nausea, and insomnia and were less likely to be delirious. They were more than twice as likely to be discharged alive than transferred inpatients. Kaplan-Meier plot tests for product-limit survival estimate from admission to APCU for EC patients and inpatients were statistically significant (median survival 34 vs. 31 days, P < 0.0001). In multivariate analysis, EC admission (odds ratio [OR] = 1.8593, 95% confidence interval [CI] 1.1532-2.9961), dyspnea (OR = 0.8533, 95% CI 0.7892-0.9211), well-being (OR = 1.1192, 95% CI 1.0234-1.2257), and delirium (OR = 0.3942, 95% CI 0.2443-0.6351) were independently associated with being discharged alive. Conclusion The EC patients have a higher acute symptom burden and are more likely to be discharged alive than transferred inpatients. The APCU was successful at managing symptoms and facilitating the discharge of both inpatients and EC patients to the community although the patients had severe symptoms on admission.
AB - Context Most patients admitted to acute palliative care units (APCUs) are transferred from inpatient oncology units. We hypothesized that patients admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes that differ from those of transferred inpatients. Objectives The purpose of this retrospective cohort study was to compare the symptom burdens and survival rate of patients admitted to an APCU from an EC with those of inpatients transferred to the APCU. Methods Among the 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 inpatients transferred to the APCU as controls (The outcome data were unavailable for two patients). We retrieved data on patient demographics, cancer diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and overall survival from time of admission to the APCU. Results The EC patients had higher rates of pain, fatigue, nausea, and insomnia and were less likely to be delirious. They were more than twice as likely to be discharged alive than transferred inpatients. Kaplan-Meier plot tests for product-limit survival estimate from admission to APCU for EC patients and inpatients were statistically significant (median survival 34 vs. 31 days, P < 0.0001). In multivariate analysis, EC admission (odds ratio [OR] = 1.8593, 95% confidence interval [CI] 1.1532-2.9961), dyspnea (OR = 0.8533, 95% CI 0.7892-0.9211), well-being (OR = 1.1192, 95% CI 1.0234-1.2257), and delirium (OR = 0.3942, 95% CI 0.2443-0.6351) were independently associated with being discharged alive. Conclusion The EC patients have a higher acute symptom burden and are more likely to be discharged alive than transferred inpatients. The APCU was successful at managing symptoms and facilitating the discharge of both inpatients and EC patients to the community although the patients had severe symptoms on admission.
KW - Acute palliative care unit
KW - emergency center
KW - symptom burden
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U2 - 10.1016/j.jpainsymman.2013.07.015
DO - 10.1016/j.jpainsymman.2013.07.015
M3 - Article
C2 - 24246788
AN - SCOPUS:84902435598
SN - 0885-3924
VL - 47
SP - 1028
EP - 1034
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 6
ER -