Learning Objective #1: Describe five variables that influence organizational decisions regarding implementation of a hospital-based palliative care service

Learning Objective #2: Identify critical components to effectively "make the case" for a palliative care service in a cure environment

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Purpose: To describe the implementation of a palliative care service in an acute care hospital. Methods: A multidisciplinary team reviewed the literature, developed metrics to determine the state of current end-of-life care utilizing a retrospective analysis of patient deaths in the previous three year period, and assessed the education level and satisfaction of nursing, allied health staff and physicians regarding end-of-life care. The retrospective analysis demonstrated similar results as other studies regarding end-of-life. For example, critical care utilization, length of stay, the number of laboratory and radiology orders, number of emergency department visits and admissions in the 12 months prior to expiration and hospice referrals all mirrored other study results. A multidisciplinary team was formed to review nursing, allied health staff and physician perception of educational preparation and the current status of knowledge regarding end-of-life care, satisfaction with the current state of end-of-life care and to analyze the appropriateness of the development of a palliative care service. A lack of knowledge and comfort with end-of-life issues was revealed. Several subgroups were formed to review the process for communication, advance directives, hospice referrals and the efficacy of alternative methods of caring for patients at the end-of-life. Outcome: Multiple educational offerings were offered for nurses, allied health staff and physicians with positive results. A pre and post-survey found that knowledge of end-of-life issues increased. The team completely revamped the advance directive patient education material and forms making them more user friendly. The financial impact for palliative care patients with regard to critical care utilization and length of stay improved. Findings were submitted in a proposal to the Board of Governors and approved in late December 2004.