Utilization of Palliative Care for Patients with Acute Kidney Injury and COVID-19 (S541) [Meeting Abstract]
Outcomes: 1. Understand the historical use of palliative care for patients with acute kidney injury (AKI) 2. Describe the use of palliative care for patients with AKI and COVID-19 during the surge at our institution 3. Describe the associations of palliative care with subsequent health care utilization such as hospice use, ICU time, and mechanical ventilation Original Research Background: Acute kidney injury (AKI) is a common morbidity seen in patients with COVID-19 and is associated with high mortality. Palliative care is valuable for these patients yet is historically underused in AKI. Research Objectives: To describe the use of palliative care and subsequent health care utilization by COVID-19 patients with AKI.
Method(s): A retrospective analysis of NYU's electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. AKI was defined by the AKI Network creatinine criteria. Regression models examined characteristics associated with a receiving palliative care and discharge to hospice versus death in the hospital.
Result(s): Patientswith COVID-19 and AKI were more likely than those without AKI to receive palliative care (42% vs 7%, p < 0.001); however, consults came significantly later (10 days from admission vs 5 days, p < 0.001). 66% of patients initiated on renal replacement therapy (RRT) received palliative care versus 37% (p < 0.001) of those with AKI not on RRT, also later in timing (12 days from admission vs 9 days, p = 0.002). Patients with AKI had a significantly longer stay, more ICU admissions, use of mechanical ventilation, discharges to hospice (6% vs 3%), and changes in code status (34% vs 7%, p < 0.001) than those without AKI. Among those who received palliative care, AKI both without RRT (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.27-0.95) and with RRT (aOR 0.18, 95% CI 0.04-0.67) was associated with a lower likelihood of discharge to hospice versus hospital death compared to those without AKI.
Conclusion(s): Palliative care was used more for patients with AKI and COVID-19 than historically reported, yet this consultation came later in the hospital course and did not avoid invasive interventions despite high mortality. Implications for Research, Policy, or Practice: These data can lead to further exploration of earlier timing of palliative care consultation in AKI.
If You Don't Ask, You Don't Get It: Implementation of a Discrimination Screening Question Palliative Care Inpatient Consults (ODS5) [Meeting Abstract]
Outcomes 1. Identify key points in medical history and current times where and how discrimination and racism have affected patient care 2. Apply and adapt the screening question on discrimination to their own institution 3. Analyze and process the material presented on incorporating a discrimination screening question in palliative care via Q/A and panel discussion The role of palliative care (PC) providers is to identify and alleviate distress, although distress due to bias and discrimination is not a standard part of PC assessments. Research clearly shows systemwide inequalities, but there is little guidance on how to directly discuss discrimination with patients. Our PC team sought to address this gap by developing a bias and discrimination screening question that is now used for all initial inpatient palliative care consultations: "During previous medical encounters have you ever felt that you were treated differently from other patients for any reason?" Our goal is to elicit patient perceptions of inequalities, create the space for patients to share their experiences, and provide therapeutic presence and listening as they discuss their perspective of discrimination and bias in healthcare. We are building a repository of patient responses that providers can use to affect change on a systemic level. We hope to implement the screening question at other campuses within our institution where there are different patient demographics. We also plan to create learning modules and platforms for continued education on a large scale. Our concurrent session is divided into three parts: background on inequity in healthcare by an expert in the field; a detailed description of how our team developed, refined, and implemented this screening question along with the challenges faced during the process; and, finally, an interactive Q&A. Through this session, we aim to motivate and equip attendees with the knowledge to implement a screening for discrimination and bias among their own PC patients, with the understanding that different institutions will have different needs. We are hopeful for widespread distribution and use of the screening question in PC. Given the sensitivity of the topic, further training and research must be completed before widespread distribution.
Utilization of Palliative Care for Patients with COVID-19 and Acute Kidney Injury during a COVID-19 Surge
BACKGROUND AND OBJECTIVES/OBJECTIVE:AKI is a common complication of coronavirus disease 2019 (COVID-19) and is associated with high mortality. Palliative care, a specialty that supports patients with serious illness, is valuable for these patients but is historically underutilized in AKI. The objectives of this paper are to describe the use of palliative care in patients with AKI and COVID-19 and their subsequent health care utilization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS/METHODS:We conducted a retrospective analysis of New York University Langone Health electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. Regression models were used to examine characteristics associated with receiving a palliative care consult. RESULTS:=0.002). Despite greater use of palliative care, patients with AKI had a significantly longer length of stay, more intensive care unit admissions, and more use of mechanical ventilation. Those with AKI did have a higher frequency of discharges to inpatient hospice (6% versus 3%) and change in code status (34% versus 7%) than those without AKI. CONCLUSIONS:Palliative care was utilized more frequently for patients with AKI and COVID-19 than historically reported in AKI. Despite high mortality, consultation occurred late in the hospital course and was not associated with reduced initiation of life-sustaining interventions. PODCAST/UNASSIGNED:This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_02_24_CJN11030821.mp3.
SIMplifying Palliative Extubations: A Two-Part OSCE in a Simulation Center to Assess Entrustable Professional Activities (EPAs) in Hospice and Palliative Medicine (TH315) [Meeting Abstract]
Objectives: * Identify the critical steps of a palliative extubation procedure. * Assess how the Palliative Extubation objective structured clinical exam (OSCE) applies to the clinical competencies of EPAs in Hospice and Palliative Medicine. * Demonstrate the innovative Palliative Extubation OSCE simulation. * Construct an educational toolkit in order to adapt and implement the Palliative Extubation OSCE simulation to your own institution. Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. Palliative extubation refers to removal of mechanical ventilator support when, based on an individual's goal of care, it is thought to be prolonging the dying process rather than helping to support through a reversible illness. Removing the endotracheal tube will allow a natural death to occur. In order to provide competent and compassionate care for patients and family members before, during, and after a palliative extubation, healthcare providers must provide a clear explanation of this complex procedure, show proficiency in performing the procedure, and demonstrate leadership skills. One method of evaluating a healthcare provider's competency in the domains of performing a palliative extubation and communication, is through use of an objective structured clinical exam (OSCE). An OSCE in a simulation center is an effective method to teach theoretical knowledge, improve hands-on skills, and assess clinical competencies while also reducing the risk of harm to patients and providers, especially for scenarios that do not occur on a daily basis. A simulation provides the advantage of providing a controlled, standardized situation, allowing for multiple interventions to be applied. This concurrent session describes an innovative Palliative Extubation OSCE in a simulation center using a mannequin as the patient and a standardized patient (SP) actor as a family member. The OSCE is divided into two parts-part 1: the family meeting and part 2: the extubation procedure. This session describes how the OSCE is structured to teach and assess the clinical competencies of the 17 EPAs in Hospice and Palliative Medicine. The session will conclude with a demonstration of the Palliative Extubation OSCE followed by small group discussions on how to implement the OSCE at participants' own institutions.
Management of pain symptoms
[S.l.] : Springer International Publishing, 2019
DELIVERS - Developing Educational Learning In Various EldeR Sites
Quality Improvement: Increasing Diabetes Knowledge in Geriatric Patients at a Safety Net Hospital [Meeting Abstract]
TIME IS OF THE ESSENCE: A PATIENT PRESENTING WITH ALTERED MENTAL STATUS AND A RISING CREATINE KINASE [Meeting Abstract]
Unsupported labeling of race as a risk factor for certain diseases in a widely used medical textbook
PURPOSE: Confounding of racial, socioeconomic, and behavioral characteristics may lead to the misidentification of race as a risk factor for certain diseases. The authors evaluated the validity of attributing race as a risk factor in a widely used pathology textbook. METHOD: In 2009-2010, the authors searched Robbins and Cotran Pathologic Basis of Disease, Professional Edition (8th ed) for assertions that African Americans have a different disease profile than do individuals of other races. They evaluated the references cited in the textbook, assessing the quality of the sources and whether those authors controlled for confounding variables, such as socioeconomic status and behavioral characteristics. For statements that remained unconfirmed, the authors searched the literature for evidence supporting or contradicting the claims made in the textbook. The authors classified each statement from the textbook as supported, unconfirmed, or contradicted. RESULTS: Of the 31 relevant statements, 11 were supported by the literature review, 17 remained unconfirmed, and three were contradicted. CONCLUSIONS: About two-thirds of the assertions that different risk factors exist for African Americans found in a widely used pathology textbook could not be supported by the published literature. Failure to separate race from other socioeconomic and behavioral characteristics as risk factors for certain diseases may contribute to the misdiagnosis of patients and interfere with efforts to identify and remove causes of health disparities.