Protocol Development for Successful Palliative Care (PC) Consultation in Population of Patients Receiving Mechanical Circulatory Support (MCS) (S701)

•Identify how close collaboration between palliative care and heart failure teams can increase documented surrogate decision makers for patients being evaluated for an MCS device.•Acknowledge collaborative effort between palliative care and cardiology as a key element for successful advanced care planning with MCS patient population. Over 1700 long-term MCS are implanted annually in the United States. In 2014, Joint Commission began requiring a palliative care (PC) consultation prior to destination therapy implantation. This recommendation is based on published data that suggests early involvement of a PC team can increase quality of life, survival time, and decrease aggressive care at the end of life. Limited information is available on established PC protocols in MCS population. Close collaboration between heart failure specialists and PC clinicians will result in significant increase in the documentation of surrogate decision makers (SDM) and development of an advanced care plan (ACP) by patient and family. In March 2014, a protocol for PC consultation at IU Health Methodist Hospital was established. A MCS referral automatically triggered a PC consultation. The goals of the PC consultation were to document ACP discussion and designate a SDM prior to implantation. Data on ACP discussion and SDM were retrospectively collected for two years prior to the new protocol through 2015. 122 patients were implanted between 1/2012 and 12/2015 (85 were males, mean age 56.1 years, 73 destination therapy, 49 bridge to transplant). Of 64 patients implanted prior to intervention, 11 received PC consult with ACP discussion and 26 had documented SDM. Post PC protocol initiation, 56 of 58 patients implanted received PC consult with ACP discussion prior to implant and 57 had SDM documented. Percent of PC consult with ACP discussion increased from 17% to 97% and SDM documentation from 41% to 98%. Defining SDM and preparing an ACP are part of the PC evaluation prior to MCS implantation. This can be used as a metric of successful utilization of a PC consultation protocol in this population.