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criteria for consideration of palliative care consult

Indications: 1) heart disease a) symptoms of CHF at rest b) LVEF of < 20% c) new dysrhythmia d) cardiac arrest e) syncope f) stroke g) frequent emergency department visits 2) cancer - metastatic or inoperable disease 3) pulmonary disease a) dyspnea at rest b) signs or symptoms of right heart failure c) hypoxia (with administration of O2) d) FEV1 < 30% of predicted e) pCO2 > 50 mm Hg f) unintentional weight loss (> 10% of body weight) 4) stroke a) acute phase of stroke unchanged after 3 days b) coma c) absent verbal response d) absent withdrawal to pain e) Karnofsky score < 50% f) recurrent aspiration pneumonia g) dysphagia precluding nutrition 5) dementia a) inability to walk b) incontinence c) fewer than 6 meaningful words d) serum albumin < 2.5 or decreased oral intake e) nutritional compromise f) severe medical comorbidities g) frequent emergency department visits 6) liver disease a) not candidate for liver transplantation b) prothrombin time > 5 seconds over control c) serum albumin < 2.5 g/dL d) refractory ascites e) spontaneous bacterial peritonitis f) jaundice g) malnutrition & muscle wasting 7) renal disease a) not a candidate for dialysis b) creatinine clearance < 15 mL/min c) serum creatinine > 8.0 mg/dL (> 6.0 mg/dL if diabetic) 8) amyotrophic lateral sclerosis a) dysphagia requiring a feeding tube b) dyspnea of symptoms of hypoventilation - forced vitatal capacity of =< 50% c) loss of function in 2 body regions (bulbar, arms or legs) d) pain requiring high doses of analgesic medications e) severe psychological &/or social or spiritual distress or suffering 9) failure to thrive a) frequent emergency department visits b) serum albumion < 2.5 g/dL c) unintentional weight loss d) decubitus ulcer(s) e) home-bound or bedridden

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palliative care

General

criteria

References

  1. Bailey FA Palliative Response http://www.hospice.va.gov/Amosbaileybook/index.htm
  2. Childers JW et al, Fast Fact an Concept #141: Prognosis in end-state COPD, Aug 2005, End-of-life Palliative Care Education Resource Center http://www.eperc.mcw.edu
  3. Fast Fact an Concept #144: Prognostication in Hear Failure, Oct 2005, End-of-life Palliative Care Education Resource Center http://www.eperc.mcw.edu
  4. Norton SA et al, Proactive palliative care in the medical intensive care unit: Effects of length of stay for selected high-risk patients. Crit Care Med 2007, 35:1530 PMID: 17452930 - Luce JM and White DB The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States. Am J Respir Crit Care Med 2007, 175:1104 PMID: 17379853
  5. National Hospice Organization. Medical guidelines for determining prognosis in selected non- cancer diseases. Hosp J 1996; 11:47