HCAT Hamilton Chart Audit Tool

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H-CATHamilton Chart Audit Tool

• Marissa Slaven MD,
• N. Henderson, B. Fitzgerald,
  
• J. Sussman MD

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H-CAT Background

• Institution to assess palliative care
• needs to develop inpatient tertiary palliative
  care unit
• Established consult service
• (1 MD, 1 APN) at each of our 3 sites
• 1060 consults in 2004

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H-CAT Background

• Not all patients receiving consults would be
  appropriate for inpatient PCU
• Many patients who dont receive consults might
  benefit from palliative care consult or PCU
  admission
• 22 of patients who died in our institutions in
  2004 had palliative care consults

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H-CAT Background

• Tool developed to capture domains frequently
  addressed by palliative care services
• Guidelines developed to use with tool allowing a
  non-clinician to use it
• 2 small validation studies performed

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Examples of Indicators Captured

• Physical Symptoms
• Pain/Discomfort
• Shortness of Breath/Dyspnea/Apnea
• Nausea/Vomiting
• Headache/Odynophagia/Dysphagia/Dysurea
• Communication
• Goals/Care Planning/Family Meeting
• Code Status
• Placement Issues
• Coping Ability
• Depression/Stress/Coping/Anxiety
• Caregiver Stress/Support

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H-CAT Background

• Tool reviews all HCP notes for a 24 hour period
• Points are scored for each symptom/element
  recorded by a health care provider
• MD notes are scored for 2 points, all other HCP
  notes are scored for 1 point
• 0-4 points
• - no palliative services needed
• 5 or more points
• - palliative services needed

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H-CATJournal of Palliative Medicine 04/2007

• Potential 983 patients who died in hospital over
  8 month period
• Excluded
• Died within 48 hours of admission (n229)
• Neonates (n33)
• Those seen by Palliative Care Consultant (n207)
• Randomly selected 222 of the remaining 514
  patients

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Demographics

• Mean age 70.5 yrs
• 55 male

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H-CATJournal of Palliative Medicine 04/2007

• 31 scored 0-4
• 19 scored 5-8
• 50 scored gt8 points
• Most commonly scored items were
• Family education and support 22.9
• Mental status changes 20.3
• Prognosis 17.6
• Pain
  13.1

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H-CATJournal of Palliative Medicine 04/2007

• Using only those that scored 8 or higher we
  projected a need to increase currently available
  palliative care services by 50
• After publication the authors received numerous
  national and international requests for more
  information on the tool

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H-CAT Validation Study

• Reviewed 222 charts from our 3 sites
• Reviewed charts of patients who had a palliative
  care consult
• Reviewed the 24 hours prior to request for consult

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H-CAT Validation Study

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H-CAT Validation Study Demographics
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H-CAT Validation Study Demographics
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Results
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H-CAT Study
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Figure Categories of H-CAT Dimensions
Documented in Patient Care Notes
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Figure H-CAT Breakdown of Variables Scored
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(No Transcript)
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H-CAT Validation Study Results

• 68.8 of patients who had a palliative care
  consult scored higher than 4 in the 24 hours
  preceding the request for consult
• Suggests that H-CAT may underestimate
• true need for palliative care services
• OR
• 31.2 of patients who received consults
• did not need them

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H-CAT Validation Study Results

• Comparing those who scored low to those who
  scored high
• 36 women scored 0-4, compared to 26 men
• Mean score for men 7.32 (n85)
• Mean score for women 6.77 (n 88)

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H-CAT Validation Study Results
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H-CAT Validation Study Results
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Conclusion

• There is a need for a validated tool to help
  institutions/programs to assess their patients
  palliative care needs for system planning
• Chart review tools are used in multiple medical
  databases and are practical for looking at large
  cohorts of patients

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Conclusion

• Further studies would be useful to confirm the
  validity of this tool

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H-CATJournal of Palliative Medicine 04,2007

• Reviewed 222 charts of patients who had died
• Excluded
• if seen by palliative care,
• if neonates,
• if died lt 48 hours after admission
• Reviewed the 24 hour period
• ( which preceded the death by 72 hrs)

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Table Categories of H-CAT Dimensions Documented
in Patient Care Notes
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Table Comparison Of Physician, Nursing and
Health Care Professional Documentation of
Palliative Care Needs
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H-CAT Validation Study Results
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H-CAT Study