Palliative medicine in a United States XXXX center: a prospective study.

@entity1 @entity1353 @entity5 @entity425 @entity158
PURPOSE: (a) To report the medical complexity of @entity5 and noncancer @entity1 receiving palliative medicine (PM) consultation at a tertiary medical center and (b) to describe the consult recommendations madefor this group. @entity1 AND METHODS: Prospective data collection was performed on all consultations ( @entity5 , n = 175; noncancer, n = 35) done by first author (JDC) as a PM fellow at the Cleveland Clinic Foundation between July 1998 and April 1999. A computer database was used to query for demographics, complexity of medical problems, current medications, mortality, symptoms, nursing problems, and consult recommendations. RESULTS: A median of three (range, 0-12) acute medical problems and three (range, 0-16) chronic medical problems were identified for each @entity1 . @entity1 were taking a median of six medications (range, 0-20). They had a median of five symptoms (range, 0-13) with @entity158 (73 percent) being most common, followed by @entity425 (40 percent) and @entity1353 (40 percent). @entity5 @entity1 were twice as likely to have more than five symptoms (48 percent versus 23 percent) (chi-square = 0.006). The most common nursing problems were ambulation or fall risk (15 percent) and skin integrity (11 percent). A median of five (range, 1-11) management recommendations were made as part of each consultation. These included medication changes in 81 percent, nonmedication changes in 53 percent, andfollow-up services in 100 percent. The median survivalfrom the time of consultation for the known dead was 29 days with 65 percent living more than 14 days. CONCLUSION: Multiple recommendations were made with most @entity1 surviving long enough potentially to benefit. Consultation in palliative medicine is a sophisticated intervention involving considerable acuity and complexity of care.
