Palliative Care: The Pioneer of a Unified End

As a 735 licensed-bed facility in a large metropolitan area, our institution often receives patients with a wide array of complex diseases, trauma, and medical diagnoses. This prompted the early recognition and implementation of an adult palliative care program within our facility in 2001. What started as a small consult service offered by a single Physician and two Registered Nurses has undergone a drastic metamorphosis. This has resulted in a robust program consisting of a physician group, Nurse Practitioners, a dedicated social worker, a dedicated chaplain, a 16-bed inpatient palliative care unit, a nurse manager, and a program coordinator. Our program goals are comprehensive and focus to enhance communication, provide family support and education, facilitate healthy coping, assist with ethical dilemmas, and establish realistic goals of care. Initially, our data included identifying common diagnoses of PC patients and determining the number of patients seen. However, our data is now comprehensive including examining the percentages of deaths in the adult ICUs with and without PC, determining “likelihood to recommend PC services” through a PC-specific patient satisfaction tool, and identifying if family conferences are multidisciplinary and establish a plan of care goal. PC services in the patients that die in the ICU, is the most impactful regarding judicious financial use for our healthcare system. The recent novelty of PC as a specialty has inherent obstacles, not unique to our program, and involves: differentiating PC from hospice, educating staff, and care fragmentation. Our future plans encompass examining the financial ramifications of cost-avoidance, constructing a process for automated PC involvement in patients admitted under the hypothermia protocol, and we are awaiting IRB approval for a quasi-experimental design study in the ICU.