422 Vol. 45 No. 2 February 2013Poster Abstracts

Result. Hospitalized HF patients receiving dis-charge referral for hospice care were older,white, had a prior history of HF, higher comor-bidities, and were more likely to receive diureticsand digoxin. During 6 month post-discharge fol-low-up, all-cause mortality occurred in 74% and21% of patients receiving and not receiving hos-pice care (p # .001). All-cause hospitalizationoccurred in 18% and 53% of patients receivingand not receiving hospice care (p # .001). HFhospitalization occurred in 8% and 24% of pa-tients receiving and not receiving hospice care(p # .001).Conclusion. Several patient and care character-istics were associated with hospice referral. Thehospice referral process seems to have identifiedmost patients who died within 6 months of refer-ral. Further, hospice referral was associated withlower hospital readmission rates.Implications for Research, Policy, orPractice. Extending hospice care to the 20%of patients not receiving referral who died within6 months of hospital discharge may improvetheir quality of life and further reduce hospitalreadmission, a CMS target for Medicare cost re-duction.

Unmet Quality Indicators of Care forMetastatic Cancer Patients Admitted to ICUin Last 2 Weeks of Life (S710)Jennifer Blechman, MD, Stanford University,Bend, OR. VJ Periyakoil, MD, Stanford Univer-sity School of Medicine, Stanford, CA.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Understand the current quality of end-of-life

care provided to patients with advanced can-cer admitted to the ICU at our academic med-ical center.

2. Discuss mechanisms to improve end-of-lifecare for patients with advanced cancer.

3. Evaluate what barriers prevented palliativecare consultation to significantly improvethe quality of end-of-life care metastatic can-cer patients receive.

Background. Evidence indicates that terminallyill cancer patients are subjected to ineffectivetreatments and do not receive quality care atthe end of life.Research Objectives. We wanted to gain a bet-ter understanding of the quality of end of life

care (EOLC) received by terminally ill cancer pa-tients admitted to the Intensive Care Unit (ICU)in the last 2 weeks of life. The established UKQuality Indicators were used to evaluate qualityof care.Method. Design: A retrospective chart review ofthe electronic medical records (EMR) of pa-tients admitted to the ICU from January-August2011 was completed. Six UK quality indicators(prognostication, advanced care planning, goalsof care, caregiver needs, coordinated care acrossorganizational boundaries, and standardizedcare pathway implementation) were used to as-sess quality of EOLC. Setting: Tertiary academicmedical center with 663 beds and 66 adult ICUbeds in Northern California, USA. Patients:2498 patients were admitted to the ICU, 232died within two weeks of admission; 69 of thesepatients died of metastatic cancer. 58% patientswere male; average age 59.8 years (range 25-91).Result. Quality indicators were met in a rela-tively small percentage of patients (prognostica-tion 67%, advanced care planning 32%, goalsof care 42%, caregiver needs 0%, coordinationof care across organizational boundaries 7%,standardized care pathway implementation58%) admitted to the ICU in the last 2 weeksof life. Palliative care consultations occurred in28 of the 69 patients and resulted in increasedPOLST documentation.Conclusion. Quality indicators for EOLC werenot met for majority of patients with advancedcancer admitted to the ICU. Earlier discussionswith patients and families regarding their goalsof care and preferred venue of death may helpimprove quality of care at EOL.Implications for Research, Policy, orPractice. Create triggers for earlier palliativecare consultation. Identify markers to measurethe quality of care patients receive at EOL.

Attitudes and Barriers of PrognosticationAcross the Internal Medicine LearnerHierarchy in an Academic Medical Center(S711)Jane Broxterman, MD, University of Kansas,Kansas City, KS. Michael Brimacombe, PhD, Uni-versity of Kansas Medical Center, Kansas City, KS.Lindy Landzaat, DO, University of Kansas Medi-cal Center, Kansas City, KS.(All authors listed above had no relevant finan-cial relationships to disclose.)