Resource Utilization in Hospitalized Patients With Cancer From Hospice Decision to Discharge and Provider-Type Differences.
Ruchi J Shah, Deborah Korenstein, Jessica R Flynn and 1 others
PMID 31749382WHAT IT FOUND
Cancer patients waiting for hospice discharge often still had lab tests: 54.6% had tests after the hospice decision.
Nurse practitioner and physician assistant teams ordered fewer tests than trainee doctor teams.
Key findings
0154.6% of patients had lab tests between hospice decision and discharge; 16.3% had radiographic studies and 8.3% underwent procedures.
02Patients discharged to home hospice had fewer days from hospice decision to discharge (2 vs 3 days), fewer lab tests (median 1 vs 2), and higher 30-day readmission (6.3% vs 0.5%) than those discharged to inpatient hospice.
03There were no differences in quality metrics between trainee doctor teams and nurse practitioner or physician assistant teams, but the latter had less lab testing (49.5% vs 59.1%; median 0 vs 2).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All patients were from one specialized cancer hospital, so results may not apply to other hospitals or patient groups. 53 of 500 sampled patients were excluded because they were discharged on the hospice decision date, so the analysis reflects 447 patients. The study was retrospective and observational; it compared staff teams and hospice sites but did not randomize care, so differences may reflect patient selection or other factors. No intervention was tested, so the study cannot show that reducing lab tests or changing discharge planning improves comfort, readmission, or quality of end-of-life care. The authors note that statistical differences in lab testing may not translate to clinical significance.
The easy way to misread this
Do not conclude that nurse practitioner or physician assistant teams provide better end-of-life care or that reducing lab tests improves outcomes. This was an observational study, and quality metrics did not differ between staff types.