CO16 | Referral of internal medicine patients to palliative care: a snapshot of some medicines in Lazio

N. Frattarelli, A. Cappelli, M. Colasanti Dionisi, V. D’Offizi, M. Lordi, C. Santini | Area studio Cure Palliative FADOI Lazio, Italy

Background: In Internal Medicine (IM), we find patients (pz) with comorbidities, hospitalized until the final stages of life. The internist is responsible for the timely identification of the need for Palliative Care (PC).
Objectives: To evaluate the referral of internal medicine patients to PC, referral times and methods, resources involved, and days spent in IM.
Materials and Methods: Selected patients for whom the internist requested PC. Reported: medications during hospitalization, macro-services, time between hospitalization and request for palliative care consultation, time of implementation, outcome, referral time, and days of hospitalization in IM, reason for referral to PC.
Results: 30 patients, average age 82, 43% admitted for cancer and 50% with between 6 and 10 drugs. 50% received major procedures. The average time between admission and request for PC was 10 days, and between request and consultation 1.5 days. Six consultations were negative and five were unsuitable. 
Referral conditions: 13 oncological, 6 multi-organ, 3 infectious, 3 pneumological, 1 cardiological, nephrological and neurological, 2 other. The average number of days between the request to the hospice and referral was 7 days, with an average of 16 days in MI. 18 were in the CP pathway, 1 was awaiting referral, and 5 died in MI.
Conclusions: The need for palliative care is greater in non-oncological conditions; in our study, the main condition is neoplastic, highlighting the difficulty in identifying end-stage disease in non-oncological patients. The use of prognostic indices for internal medicine patients can reduce hospital stays, anticipate the identification of patients requiring palliative care, and reduce macro-procedures, cost, and deaths in the ICU.