Background: Palliative care services provide symptom control and psychosocial support for
dying patients and their families. These services are not available in many cancer centers and
tertiary hospitals. The purpose of this study was to review the impact of a palliative care program,
established in 1999, on overall in-hospital mortality.
Methods: We reviewed the M. D. Anderson Cancer Center computerized database to determine
the total number of deaths and discharges and the place of death for each fiscal year
from 1999 to 2004. The median length of stay for patients who died in different locations
within the hospital was calculated. Annual palliative care consultations for patients who subsequently
died in the hospital were retrieved. The annual mortality rate for the cancer center
was calculated.
Results: The overall in-hospital mortality rates were 3.6, 3.7, 3.6, 3.5, 3.6, and 3.7% of all discharges
for the period 1999–2004 respectively (p > 0.2). The number of deaths in the medical
intensive care unit (MICU) dropped from 252 in 671 (38%) in 1999 to 213 in 764 (28%) in 2004
(p < 0.0001). Involvement of the palliative care service in the care of patients dying in the hospital
grew from 8 in 583 (1%) in 1999 to 264 in 764 (35%) in 2004 (p < 0.0001). The median
length of hospital stay (MLOS) for patients who subsequently died in-hospital was significantly
longer than that for patients who were discharged alive.
Conclusions: Increased involvement by the palliative care service in the care of decedent
patients was associated with a decreased MICU mortality and no change in overall hospital
mortality rate or inpatient length of hospital stay.
