Establishment of Surgeon-Led Palliative Care Teams in a University Hospital: Measured Outcomes

Abstract

Objective: To investigate whether establishment of surgeon-led multidisciplinary palliative care teams at our hospital has resulted in measurable benefits for patients with terminal-stage disease.
Subjects and Methods: Subjects were 101 patients who visited the Department of Gastrointestinal and General Surgery at St. Marianna University Hospital during the 1-year period of August 2005 through July 2006. The chief complaint in all cases was oncogenic pain. Realizing that it would take time for our new system to have an effect, we divided these patients into an early-period group (August 2005–January 2006) and a late-period group (February 2006–July 2006), and we compared outcomes between the 2 groups and various subgroups. The length of patients’ hospital stay was taken as the main outcome of interest because we considered it to be the clearest measurable indicator of a direct effect of our team approach to palliative care.
Results: Mean±SD hospital stay was 50.36±64.63 days for the early-period group and significantly shorter at 35.09±27.64 days for the late-period group. (p=0.044). The hospital stay also differed significantly between long-term in-patients (those hospitalized 60 days or more) in the early-period group and those in the late-period group (152.33±100.87 days vs. 82.75±23.12 days, respectively; p=0.016). The hospital stay of early-period patients who died was 64±82.87 days, and that of late-period patients who died was significantly shorter at 32±19.77 days (p=0.015). The positive outcomes of the team-based palliative care appeared to arise from the ability of the team specialists to alleviate patients’ symptoms and release them to home treatment.
Conclusion: We conclude that establishment of specialized palliative care teams yields a significant benefit to terminal-stage cancer patients that is manifested by shortened hospital stays.