Screening for Palliative Care Patients By Utilizing Clinical Decision Support Within the Electronic Health Record

Sunday, 30 July 2017

Tanja Baum, PhD, RN
Ruth A. Bush, PhD, MPH
Caroline Etland, PhD, RN
Cynthia D. Connelly, PhD, RN, FAAN
Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA


Approximately $1.3 million annually can be saved when 500 palliative care consults are completed within the acute care setting. With 90 million Americans, of whom 20% are Medicare recipients that suffer from chronic medical conditions, 500 consults are not a distant number. The electronic clinical decision support and utilization of triggers to identify individuals who might benefit from palliative care using an algorithm within the electronic health record (EHR) can enable the multidisciplinary team to facilitate palliative care services.

The purpose of this feasibility study was to utilize variables available in the EHR of palliative care patients receiving palliative care services (PCS) in the acute care setting.

Aim 1) Characterize EHR data related to palliative care consultations among severely and chronically ill patients in the acute care

Aim 2) Examine relationships between the list of clinical EHR data, and select demographics (age, gender, race, ethnicity, religion), in a sample of palliative care patients


A descriptive, correlational study using de-identified retrospective data, collected from January 1, 2013 to December 31, 2015. An institutionally derived list of variables was used to provide a foundation for clinical decision support and patient identification integrated into the Cerner EHR system. Data were derived from three hospitals of a large multi-community healthcare system in San Diego County, California (USA). Descriptive and inferential statistical analyses conducted using SPSS version 23.


A randomized sample yielded 694 palliative care patients seeking acute care treatment at one of the three hospitals. Significant associations were found between patients' race/ethnicity and code status (X2= 11.26, p .16), and language and the presence of an advance directive or physician orders for life-sustaining treatment (POLST) (X2= 13.845, p .008).


Using a large sample, a number of statistically significant demographic, physiologic, and clinical variables were found. Integrating the EHR system to its fullest can not only aid nursing, but the entire interdisciplinary team in enhancing quality of life of palliative care patients and their families. Documents such as the advance directive or the POLST can be saved electronically and are readily available throughout the entire hospital system. Furthermore, multiple translated versions may be available for the patient, decreasing language barriers that could prevent patients from making their wishes known. Further research is needed to include the entire hospital popoulation and to extend beyond a single healthcare system to increase diversity.