Impact of a Mandatory Palliative Care Consultation Protocol Following Severe Intracranial Hemorrhage

Introduction: Intracranial Hemorrhages (ICH) can have potentially devastating outcomes for patients. Although severe ICH, with an ICH score of 3 or greater, has been associated with a 30-day mortality as high as 72%, it has not been standard of care to obtain palliative care consultations for these patients. Palliative care services have been demonstrated to have high patient and caregiver satisfaction, while potentially decreasing hospital costs and length of stay. Below, we report our outcomes after implementing automatic palliative care consultations for patients with an ICH score of 3 or greater.

Methods: This was a retrospective cohort study comparing patients admitted with an ICH score of 3 or greater, prior to the implementation of the palliative care protocol (N=44) and after its implementation (N=65). Medical records were queried for demographics, length-of-stay (LOS), and disposition, while insurance claims data was assessed for costs associated with the admission and the subsequent 3 months. Post-discharge interviews were administered to the cohort with automatic palliative care consultations. Statistical analysis was performed using GraphPad Prism 9.4.1.

Results: On follow-up interviews, caregivers reported satisfaction with palliative care services with 46.2% and 48.7% of respondents reporting a 5 and a 4, respectively, out of 5 points. Furthermore, 83% of respondents reported a change in their understanding of palliative care. Both cohorts had a similar LOS (7.1 ± 8.4 days for the pre-intervention cohort and 7.1 ± 9.3 days for the protocol cohort, p=0.99), and similar rates of discharge to hospice (30.0% vs 24.6%, p=0.40). Total costs of the hospitalization were likewise similar ($42,618 ± $66,672 vs $83,548 ± $91,858, p=0.17).

Conclusion : Palliative care consultation following severe ICH can promote family satisfaction without increasing the length-of-stay for patients or the cost associated with their treatment. This study provides valuable information for hospitals with a high volume of ICH patients.