Learning Objective #1: identify components of a successful outpatient palliative program.

Learning Objective #2: know how a multidisciplinary team intervention can work with non-hospitalized patients promotes quality while decreasing cost.

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Terminal patients are often admitted to the hospital at end of life because caretakers do not have the knowledge and skills necessary to help them to remain at home. Further, the inappropriate hospitalization and undesired rescue care of dying patients is another reason for unnecessary rising healthcare costs. The purpose of this study was to examine the effectiveness of an innovative, outpatient intervention directed toward end of life care. The nurse-led multidisciplinary intervention addressed distressing symptoms, level of function, patient and caregiver understanding of terminal illness management, and emotional and spiritual needs to assist the patient and family to achieve a peaceful end of life experience at home. Data was collected from 53 stage IV cancer patients discharged, over a nine month period, from a 550 bed hospital in the Midwest. The palliative care conducted an initial interview, and then contacted patients every two weeks by telephone to discuss symptoms, goals, and progress as well as answer questions. The multidisciplinary team met weekly to discuss patients and their needs.  Data from the hospital and clinic records were compared to a control group over the same time a year earlier. Unplanned related readmissions to the hospital dropped from 32.5% to 11.11%.  Of patients readmitted to the hospital, morbidity fell from 7.7% to 3.8%, mean length of stay dropped from 5.7 to 5.2 days, and mortality dropped from 11.4% to 4.3%. The cost of the study was $15,370.00, with an average cost per case of $290.00.  Findings support the need for comprehensive outpatient management of terminal patients.