Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis.

Abstract:

BACKGROUND:The highest healthcare expenditures occur towards the end of life. Costs relate to hospital admissions and investigations to diagnose, prognosticate and direct treatment. AIMS:AnAustralian study to compare the cost of investigations in the last 72 h of life between an inpatient palliative care unit (PCU) and a tertiary hospital. METHOD:We retrospectively reviewed 50 adult medical and surgical patients (admitted for >72 h and who died in hospital) from the PCU and referring tertiary centre between March and July 2016. Patients in the emergency department, intensive care, medical assessment and paediatric and obstetric units were excluded. All patients had an acute resuscitation plan and were on the 'Care of the Dying' pathway. RESULTS:Expenditure was less if palliative care were the primary caregivers, with statistically significant differences in the amount of imaging (P < 0.001) and pathology (P < 0.001) ordered. There was no difference in microbiology (P = 0.172) and histology (P ~ 1) ordered. Total cost of investigations for PCU patients was $1340.60 (4 of 50 patients) compared with $9467.78 (29 of 50 patients) in the tertiary hospital. PCU patients had longer lengths of stay (15.54 days vs 11.06 days) but cost less per bed day ($868.32 vs $878.79 respectively). CONCLUSION:Inpatient PCU are less likely to order investigations and are more cost-effective. A prospective study comparing an inpatient PCU and patients at a tertiary centre, with and without consult liaison palliative care input, would be worthwhile to see if outcomes remain the same and if consult liaison palliative care affects the investigative burden.

journal_name

Intern Med J

authors

Gogna G,Broadbent A,Baade I

doi

10.1111/imj.14623

subject

Has Abstract

pub_date

2020-05-01 00:00:00

pages

590-595

issue

5

eissn

1444-0903

issn

1445-5994

journal_volume

50

pub_type

杂志文章
  • Metastatic breast cancer in young women: a population-based cohort study to describe risk and prognosis.

    abstract:BACKGROUND:There is limited information on the risk of metastatic breast cancer (MBC) to inform younger women, particularly those under 40 years. AIMS:We conducted a retrospective analysis of a population-based cohort study to describe the risk, site and prognosis of MBC in young women under 40 years with an initial d...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.12481

    authors: Tjokrowidjaja A,Lee CK,Houssami N,Lord S

    更新日期:2014-08-01 00:00:00

  • Clinical audit of the use of fresh-frozen plasma and platelets in a tertiary teaching hospital and the impact of a new transfusion request form.

    abstract:AIM:To carry out an audit of the appropriateness of fresh-frozen plasma (FFP) and platelets (Plt) transfusion with reference to the Australian National Health and Medical Research Council/Australian Society of Blood Transfusion Clinical Practice Guidelines, and to assess the impact of a self-educating transfusion reque...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2005.00803.x

    authors: Hui CH,Williams I,Davis K

    更新日期:2005-05-01 00:00:00

  • Association between socioeconomic status and incident atrial fibrillation.

    abstract:BACKGROUND:Low socioeconomic status is associated with cardiovascular diseases, and an association with atrial fibrillation (AF) could guide screening. AIM:To investigate if indices of advantage/disadvantage (IAD), index of education/occupation (IEO) and index of economic resources were associated with incident AF, in...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14214

    authors: Ramkumar S,Ochi A,Yang H,Nerlekar N,D'Elia N,Potter EL,Murray IC,Nattraj N,Wang Y,Marwick TH

    更新日期:2019-10-01 00:00:00

  • Ironic case of hepatic dysfunction following the global withdrawal of sitaxentan.

    abstract::A patient with pulmonary arterial hypertension secondary to systemic sclerosis was successfully treated with sitaxentan prior to its worldwide withdrawal (because of hepatotoxicity concerns), but then ironically experienced acute hepatic dysfunction during substitute bosentan therapy, and was eventually stabilised on ...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.12007

    authors: Don GW,Joseph F,Celermajer DS,Corte TJ

    更新日期:2012-12-01 00:00:00

  • From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda.

    abstract::This paper uses a case example to review the current legal status of advance directives, as well as their ethical rationale. We draw attention to ongoing efforts to institutionalize advance directives, and to some of the tractable and intractable reasons why advance directives are ineffective. We then introduce the co...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2005.00915.x

    authors: Jordens C,Little M,Kerridge I,McPhee J

    更新日期:2005-09-01 00:00:00

  • Alcohol Misuse and Critical Care Admissions in the Northern Territory.

    abstract:BACKGROUND:The Northern Territory (NT) has a long history of heavy alcohol consumption with a correspondingly high attributable morbidity and mortality. AIMS:We aimed to describe the number of admissions to Intensive Care associated with alcohol misuse. METHODS:Prospective case-control study including all admissions ...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.15212

    authors: Secombe P,Campbell L,Brown A,Bailey M,Pilcher D

    更新日期:2021-01-19 00:00:00

  • Clinical audit: virological and immunological response to combination antiretroviral therapy in HIV patients at a Sydney sexual health clinic.

    abstract:AIM:Bigge Park Centre (BPC) is a sexual health clinic located in a socially disadvantaged area in Southwest Sydney. This served as a retrospective clinical audit, documenting patient demographics, identifying factors associated with virological, immunological and discordant responses, evaluating the centre's ability in...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2009.01983.x

    authors: Hsu DC,Quin JW

    更新日期:2010-04-01 00:00:00

  • Consensus guidelines for 'rainy day' autologous stem cell harvests in New South Wales.

    abstract::Autologous stem cell transplantation (ASCT) has a well-established role in the treatment of haematological malignancies. Stem cells are commonly collected following salvage chemotherapy although there may be advantages in collecting earlier in the disease course. A 'rainy day' harvest (RDH) refers to the collection of...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2008.01632.x

    authors: Trotman J,Presgrave P,Kwan Y,Tiley C,Estell J,Watson AM,O'Brien TA,Peters D

    更新日期:2008-04-01 00:00:00

  • Survival after the initiation of combination therapy in patients with pulmonary arterial hypertension: an Australian collaborative report.

    abstract:BACKGROUND:  Several cellular pathways are implicated in the pathogenesis of pulmonary arterial hypertension (PAH) and attempts to arrest disease progression with a single drug would not be expected to succeed in the medium term. In clinical practice, combination therapy is often used in patients deteriorating on monot...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,多中心研究

    doi:10.1111/j.1445-5994.2010.02403.x

    authors: Keogh A,Strange G,Kotlyar E,Williams T,Kilpatrick D,Macdonald P,Brown K,Pidoux A,Kermeen F,Steele P,Dalton B,Gabbay E

    更新日期:2011-03-01 00:00:00

  • Guidelines for the use of antifungal agents in the treatment of invasive Candida and mould infections.

    abstract::ABSTRACT Treatment of invasive fungal infections is increasingly complex. Amphotericin B deoxycholate has long been the mainstay of treatment. However, there has been increasing recognition of both the propensity for nephro-toxicity in haematology, transplant and intensive care patients as well as its adverse impact o...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/j.1444-0903.2004.00541.x

    authors: Slavin MA,Szer J,Grigg AP,Roberts AW,Seymour JF,Sasadeusz J,Thursky K,Chen SC,Morrissey CO,Heath CH,Sorrell T

    更新日期:2004-04-01 00:00:00

  • Australia-Wide Cross-Sectional Survey of General Practitioners' Knowledge And Practice Of Lung Cancer Screening.

    abstract:BACKGROUND:Low dose computed tomography (LDCT) screening can reduce lung cancer deaths in high risk individuals yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia. METHODS:A survey was distributed to a nationally-representative sample of 4000 Au...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14838

    authors: Abeyweera PD,Brims FJH,Piccolo F,Lei C,Manners D

    更新日期:2020-04-01 00:00:00

  • Is there any role for computed tomography measurements of medial temporal lobe atrophy in dementia? A review of the literature and case series from a memory clinic.

    abstract::Neuroimaging in dementia has focused on documenting any burden of vascular disease or excluding any reversible intracranial pathology. We review the use of computed tomography to examine for medial temporal lobe atrophy in dementia and compare this with a case series of such measurements from our memory clinic. Measur...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/j.1445-5994.2007.01598.x

    authors: Rose M,Scharf S

    更新日期:2008-02-01 00:00:00

  • Differential clinical characteristics, management and outcome of delirium among ward compared with intensive care unit patients.

    abstract:BACKGROUND:Delirium is common in hospitalised patients but its epidemiology remains poorly characterised. AIMS:To test the hypothesis that patient demographics, clinical phenotype, management and outcomes of patient with delirium in hospital ward patients differ from intensive care unit (ICU) patients. METHODS:Retros...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14287

    authors: Canet E,Amjad S,Robbins R,Lewis J,Matalanis M,Jones D,Bellomo R

    更新日期:2019-12-01 00:00:00

  • Planning and clinical role of acute medical home care services for COVID-19: consensus position statement by the Hospital-in-the-Home Society Australasia.

    abstract::During a pandemic when hospitals are stretched and patients need isolation, the role of hospital-in-the-home (HITH) providing acute medical care at home has never been more relevant. We aimed to define and address the challenges to acute home care services posed by the COVID-19 pandemic. Planning for service operation...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.15011

    authors: Bryant PA,Rogers BA,Cowan R,Bowen AC,Pollard J,Hospital-in-the-Home Society Australasia.

    更新日期:2020-10-01 00:00:00

  • Urgent liver transplantation for acute liver failure due to parvovirus B19 infection complicated by primary Epstein-Barr virus and cytomegalovirus infections and aplastic anaemia.

    abstract::An 11-year-old boy presented with hepatic failure secondary to parvovirus B19 infection, requiring urgent liver transplantation. His recovery was complicated by primary Epstein-Barr virus and cytomegalovirus infections. He subsequently developed aplastic anaemia that has been refractory to antithymocyte globulin and c...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2006.01293.x

    authors: So K,Macquillan G,Garas G,Delriviere L,Mitchell A,Speers D,Mews C,Augustson B,de Boer WB,Baker D,Jeffrey GP

    更新日期:2007-03-01 00:00:00

  • Understanding and reducing work-related psychological distress in interns: a systematic review.

    abstract::The aim of this study was to collate and evaluate studies investigating either the factors influencing work-related psychological distress in postgraduate year one (PGY1) doctors or the strategies designed to reduce it. This is a systematic review conducted in May 2014. The data sources were key databases (MEDLINE, Ps...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/imj.12785

    authors: Facey AD,Tallentire V,Selzer RM,Rotstein L

    更新日期:2015-10-01 00:00:00

  • Bronchiectasis.

    abstract::Bronchiectasis is generally classified into cystic fibrosis and non-cystic fibrosis bronchiectasis. This review article describes non-cystic fibrosis bronchiectasis in adults. Bronchiectasis can be considered a heterogeneous condition characterized by irreversible airway dilatation with chronic bronchial infection/inf...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/j.1445-5994.2006.01219.x

    authors: King P,Holdsworth S,Freezer N,Holmes P

    更新日期:2006-11-01 00:00:00

  • They just don't get enough! Variable intern experience in bedside procedural skills.

    abstract:BACKGROUND:Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures. METHODS:Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of ex...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2009.01699.x

    authors: Boots RJ,Egerton W,McKeering H,Winter H

    更新日期:2009-04-01 00:00:00

  • Impact of limited English proficiency on presentation and outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

    abstract::Doctor-patient language discordance has been shown to lead to worse clinical outcomes. In this study of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction at an Australian health service, we demonstrated that limited English proficiency (LEP) is an independent predict...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.13751

    authors: Biswas S,Seman M,Cox N,Neil C,Brennan A,Dinh D,Walton A,Chan W,Lefkovits J,Reid C,Stub D

    更新日期:2018-04-01 00:00:00

  • Stress and burden faced by family caregivers of people with schizophrenia and early psychosis in Hong Kong.

    abstract:BACKGROUND/AIM:Families, especially in Chinese society, play a crucial role in care provision for relatives with schizophrenia, but the burden of caregiving has shown to cause significant distress among caregivers. The aim of the study is to assess the degree of stress and burden among caregivers of relatives with schi...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,多中心研究

    doi:10.1111/imj.14166

    authors: Wan KF,Wong MMC

    更新日期:2019-03-01 00:00:00

  • Carbimazole-induced agranulocytosis: does antineutrophil cytoplasmic antibody have a role?

    abstract::Carbimazole is a drug that is widely used for hyperthyroid disorders, such as Graves' disease. Agranulocytosis is a rare idiosyncratic adverse reaction to the drug which is potentially fatal. This report describes a patient with a history of successfully treated pyoderma gangrenosum, who developed agranulocytosis 3 we...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/j.1445-5994.2009.02143.x

    authors: Yip G,Ekinci E,Lee ST,Jerums G,Grossmann M

    更新日期:2010-04-01 00:00:00

  • Modelling cost-effectiveness of high-dose chemotherapy as treatment for relapsed aggressive non-Hodgkin lymphoma in an Australian setting.

    abstract:BACKGROUND:Since 1995 patients with relapsed aggressive non-Hodgkin lymphoma have been treated with high-dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival shown in the 'Parma study'. As HDC involves hospital admission and intensive supportive care, the cost of HDC would be ...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1445-5994.2008.01795.x

    authors: Prajogo J,Neil A,Duke J,Zhang H,Stokes B,Rowlings P

    更新日期:2009-08-01 00:00:00

  • Diagnosis and management of pregnancies complicated by haemolysis, elevated liver enzymes and low platelets syndrome in the tertiary setting.

    abstract:BACKGROUND:Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome occurs in one to six per 1000 pregnancies; maternal death has been reported in 1-24% of cases. Vague presentation is common; hypertension and proteinuria which characterise pre eclampsia are often absent when HELLP syndrome presents. Physi...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14337

    authors: Jayawardena L,Mcnamara E

    更新日期:2020-03-01 00:00:00

  • Pharmaceutical Benefits Scheme criteria for the use of tumour necrosis factor-alpha inhibitors in the treatment of ankylosing spondylitis in Australia: are they evidence based?

    abstract:BACKGROUND:In 2004, the Pharmaceutical Benefits Scheme (PBS) listed infliximab as a subsidised treatment for ankylosing spondylitis (AS). Eligibility to receive this treatment for AS involved fulfilling several criteria. AIM:To examine the medical literature concerning response to tumor necrosis factor (TNF)-alpha inh...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/j.1445-5994.2006.01004.x

    authors: Smith MD,Ahern MJ

    更新日期:2006-02-01 00:00:00

  • Predictive value of soluble suppression of tumourigenicity 2 on myocardial reperfusion.

    abstract:BACKGROUND:High baseline level of soluble suppression of tumourigenicity 2 (sST2) was an independent predictor of cardiovascular death and heart failure in ST-segment elevation myocardial infarction (STEMI). AIMS:To investigate the value of serum sST2 baseline levels in predicting myocardial reperfusion in patients wi...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14639

    authors: Bai S,Liu H,Wu H,Wang X,Li R,Li X,Li X,Zhang L,Chen T,Du R

    更新日期:2020-08-01 00:00:00

  • Spontaneous pneumothorax: time for some fresh air.

    abstract::Conventional teaching on the mechanisms and treatment of spontaneous pneumothorax is either obviously wrong or based on a misunderstanding of the natural history of the condition. Spontaneous pneumothorax is a generally benign, self-limiting condition where conservative management should be considered. If intervention...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/j.1445-5994.2009.02155.x

    authors: Simpson G

    更新日期:2010-03-01 00:00:00

  • Euglycaemic diabetic ketoacidosis in patients using sodium-glucose co-transporter 2 inhibitors.

    abstract::Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are an increasingly prescribed class of medication for type 2 diabetes mellitus. Euglycaemic diabetic ketoacidosis (euDKA) has been reported in association with SGLT2i use. Clinicians need to understand how to recognise and treat this complication. We describe three ...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.13442

    authors: Isaacs M,Tonks KT,Greenfield JR

    更新日期:2017-06-01 00:00:00

  • No effect of sleeved arms on the accuracy of blood pressure measurement.

    abstract:BACKGROUND:It is recommended that blood pressure should be measured on a bare upper arm with an appropriately sized cuff. However, in practice, it is more convenient to measure blood pressure on sleeved arms. AIMS:We aim to examine the effect of sleeved arms on the accuracy of blood pressure measurement. METHODS:Pati...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.15071

    authors: Li Y,Li Y,Li F,Liu D,Zhang Y,Cui X,Cui W

    更新日期:2020-09-25 00:00:00

  • Comparison of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and Adult Sepsis Pathway in Predicting Adverse Outcomes among Adult Patients on General Wards: A Retrospective Observational Cohort Study.

    abstract:BACKGROUND:Quick Sepsis-related Organ Failure Assessment (qSOFA) is recommended for use by the most recent international sepsis definition taskforce to identify suspected sepsis in patients outside the Intensive Care Unit (ICU) at risk of adverse outcomes. Evidence of its comparative effectiveness with existing sepsis ...

    journal_title:Internal medicine journal

    pub_type: 杂志文章

    doi:10.1111/imj.14746

    authors: Li L,Rathnayake K,Green M,Shetty A,Fullick M,Walter S,Middleton-Rennie C,Meller M,Braithwaite J,Lander H,Westbrook JI

    更新日期:2020-01-06 00:00:00

  • Individualised medicine: why we need Bayesian dosing.

    abstract::Individualised drug dosing has been shown to improve patient outcomes and reduce adverse drug events. One method of individualised medicine is the Bayesian approach, which uses prior information about how the population responds to therapy, to inform clinicians about how a specific individual is responding to their cu...

    journal_title:Internal medicine journal

    pub_type: 杂志文章,评审

    doi:10.1111/imj.13412

    authors: Donagher J,Martin JH,Barras MA

    更新日期:2017-05-01 00:00:00