Vol. 43 No. 2 February 2012 471Poster Abstracts

a psychosocial assessment tool in an acute palli-ative care setting to determine its effects on theutilization and quality of interdisciplinary team(IDT) interactions with patients and families.Lack of a standardized process for IDT utiliza-tion impedes workflow and impacts the qualityand access of IDT resources for patients andfamilies. Implementing use of a psychosocial as-sessment tool in an acute palliative care settingcan enhance quality and access of IDT supportfor patients and families.

Case Description. The psychosocial tool utilizedfor this case study was based upon the SupportTeam Assessment Schedule (STAS). All IDTmembers received training on use of the STAS.The psychosocial assessment tool was completedby the health care provider admitting or trans-ferring the patient to the Palliative and ComfortCare Unit (PCCU). IDT members used the STASto triage encounters and focus interventions.Data were obtained through chart review fo-cused on documentation of the (pre) social his-tory portion of the initial history and physicalcompared to the (post) STAS assessment form.Analysis is ongoing and will be completed beforethe time of the 2012 Assembly.

Conclusion. Possible implications include im-provement in quality of IDT documentation,facilitation of workflow in the PCCU by eliminat-ing repetitive narratives on patient issues, andcontributing evidence substantiating the utiliza-tion of IDTs palliative care in order to seek fund-ing for support for these programs.

Where Do We Die in a Hospital? (785)Anne Rizzo, MD FACS, INOVA Fairfax Hospital,Falls Church, VA. Tayseer Aldaghlas, MD,INOVA Fairfax Hospital, Falls Church VA. Jessi-ca Heintz, MD, INOVA Fairfax Hospital, FallsChurch VA. Kirsten Edmiston, MD, INOVA Fair-fax Hospital, Falls Church VA.

Objectives1. Understand that there has been a significant

increase in the amount of patients that diein the hospital in the past 50 years, specificallyin critical care units.

2. Understand the increasing burden of pallia-tive care cost on medicare and its threat toacute care services at hospitals.

3. Understand the level of palliative care.

Background. In the last 50 years our place ofdeath has changed from the home to the

hospital. Location of death also is followingchanging demographics of the American popu-lace. Hospitals are seeing increases in peri-deathcare with medicare estimates that 30-50% ofmedical expenses are spent in the last days oflife. If this trend continues acute care servicesat hospitals could be in jeopardy.

Research Objectives. This study examines the lo-cation of deaths within hospitals to help imple-mentation of palliative care initiatives.

Method. Apalliative care initiativewasundertakento notify and educate providers of the servicesavailable for patients. Tomonitor the implementa-tion of the program, collection of data from Fair-fax County as well as data from the INOVAhealth system, consisting of five hospitals. Datawas analyzed with simple statistics to stratify thepopulation at risk as well as services rendered.

Result. Fairfax County is the most populouscounty in Virginia with 1,464,216 residents.With this high population density, the county re-cords over 200,000 emergency department (ED)visits per year. There were 4864 admissions/100,000 residents to acute care hospitals in2010, this has increased from 1293 admissions/100,000 in 2004 (300% increase) for a total of71,000 admissions in 2010. 1790 patients diedin the hospital while 7486 patients died countywide. The majority of the patients 53.6% diedin a critical care setting with the ED being sec-ond most likely location for deaths.

Conclusion. This study has defined that patientsdying in the hospital are in critical care settingsand what proportion of deaths are occurring inthe hospital. Future areas of study include: pa-tient type, length of stay, service of admissionto help delineate use of palliative care servicesin this patient population.

Implications for Research, Policy, or Practice.This study will help with the implementationof palliative care initiatives.

Caregiver Distress of the Primary Caregiver(PCG) Is Associated With Severity ofPatients Pain, Anxiety Levels and the PCGAnxiety and Depression (786)Yennurajalingam Sriram, MD, MDAndersonCan-cer Center, Houston, TX. Edurardo Bruera, MD,UT MD Anderson Cancer Center, Houston, TX.

Objectives1. To identify which patient and caregiver char-

acteristics associated with distress in primary

472 Vol. 43 No. 2 February 2012Poster Abstracts

caregiver of the patient receiving palliativecare at outpatient palliative care.

2. To identify which patient and caregiver charac-teristics that contribute to Caregiver burden.

Background. Primary Caregivers (PCG) of pa-tients receiving palliative care report high levelsof distress (Caregiver burden).

Research Objectives. The aim of the study is toidentify which patient and caregiver characteris-tics that contribute to Caregiver burden.

Method. In this study we reviewed the baselinedata of patients and primary caregivers obtainedfor a prospective study at outpatient palliativecare clinic to evaluate patient’s characteristics,physical and psychological symptoms and pri-mary caregivers’ psychological symptoms anddistress using standardized measures includingBrief Pain Inventory (BPI), Edmonton symptomassessment scale (ESAS)(SDS), Zarit’s BurdenInterview (ZBI), Depression Anxiety stress sca-le(DASS). A multivariate analysis was performedwith ZBI as a dependent variable, with patientand caregiver characteristics, symptoms, care-giver’s DASS as independent variables.

Result. Thirty-three PCG participated. The me-dian (range) patients ESAS (Pain) 6{2e10};SDS 42 (10e65); BPI (W) 7 (3e10). The PCGZBI score was 24 (6e48), DASS 14 (2e82). Care-giver burden was associated with patient’s sever-ity of (BPI- worst pain) {B ¼ �0.89, P ¼ 0.02},anxiety (ESAS) {B ¼ 0.837, P ¼ 0.83} and care-giver’s anxiety depression and distress (DASSscores) {B ¼ 0.551, P ¼ 0.04}

Conclusion. Caregiver distress of the PCG is asso-ciated with severity of patient’s pain, anxietylevels and the PCG anxiety and depression.

Implications for Research, Policy, or Practice.Further studies are needed to develop palliativecare strategies including pain education to pa-tient and PCG’s so as to reduce PCG distress.

Development of Palliative MedicineConsensus Guidelines for Consults in theEmergency Department (787)Denise Waugh, MD FACEP FAAHPM, Scott andWhite Healthcare, Temple, TX.

Objectives1. Participants will understand the current bar-

riers to palliative care consults generatedfrom the emergency department.

2. Participants will review the results of theexpert consensus panel on guidelines for pal-liative care consultations in the emergencydepartment.

3. Participants will compare and contrast theseresults with those of CAPC, the American Col-lege of Critical Care Medicine and C.T. Brad-ley’s group of expert palliative surgeons(Guidelines for the SICU).

Background. Within the Emergency Departmentsystem, geared to diagnosis and rapid stabiliza-tion, there are an increasing number of patientswho present for intensive symptom managementand chronic illness. There is a need to developand implement a non-burdensome process toidentify Emergency patients needing palliativecare so patients, family and involved ED staffwill all benefit from Palliative Medicineintervention.Research Objectives1. Identify a set of expert consensus guidelines

for identification of ED patients that are likelyto benefit from specialist palliative care.

2. Publish the consensus guidelines in emer-gency medicine literature to educate ED staffabout when to consult PC.

Method. Using an email-based Delphi tech-nique, a group of local and national experts inboth Emergency Medicine and Palliative Medi-cine were queried in a series of 3 rounds to agreeon a group of scenarios most appropriate for EDgenerated Palliative Care consults.

Result. The initial rounds and final consensusguidelines will be discussed. The relationship be-tween these results and those formulated byCAPC, the American College of Critical CareMedicine and C.T. Bradley’s group of expert pal-liative surgeons will be reviewed for similaritiesand differences.

Conclusion. Based on data from an email-basedDelphi consensus panel, a set of guidelines forappropriate ED driven PC consults were agreedupon.

Implications for Research, Policy, or Practice.Similar methods have been used to identifyguidelines for palliative care in the ICU andSICU and have assisted with the integration ofPC in these settings. It is hoped that the publica-tion of these guidelines will lead to increased ed-ucation and utilization of PC in this particularlyvulnerable population of ED patients. As we con-centrate our efforts on this area of significant