One Health Care System’s Commitment to Providing Palliative Care Across the Continuum
Andrew Esch, MD MBA
Karen Washburn MSW ACSW
Director QLife/Palliative Care
Lee Memorial Health System
8931 Colonial Center Drive, Suite 200
Fort Myers Florida 33905
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The Lee Memorial Health System (LMHS) is comprised of 4 acute care hospitals with 1423 licensed beds, an ambulatory surgery center, a regional cancer center, nursing homes and post acute home care services. Annually the system has roughly 70,000 hospital admissions, 200,000 emergency room visits, 10,000 trauma center visits, 40,000 surgeries, and 9300 employees. The LMHS QLife/Palliative Care program touches the lives of the patients in Southwest Florida by seeing over 4,000 new hospital consults every year. Consultations were historically done by palliative care teams in the four hospitals. Since 2010 the hospital system committed resources to allow the Palliative Care program to provide ongoing palliative care involvement post hospitalization to patients in our nursing homes, outpatient palliative care clinic and a home based palliative care nursing program. The palliative care program has continued to grow the hospital consult service (65% growth since 2008, 4000 new consults per year), developed and implemented a nursing home consult service, developed and launched an outpatient integrated palliative care clinic and has provided education and oversight to a newly developed home based nursing palliative care program. Through these efforts the health system provides palliative care across the continuum for the patients of Southwest Florida.
The non hospital programs were added through needs assessment performed through a joint effort of the palliative care team and hospital administration. Key indicators were continuity/quality of care, hospital readmission rates and in-hospital mortality rates. Patients that had involvement with the Qlife Palliative Care team in the hospital had 15 day readmission rates that were half of the LMHS 15 day readmit rate and more than half versus VHA methodology. Hospice admissions increased 39% since 2008 and hospice house admissions directly from ICU increased 108% during this same time period. The hospital also experienced an 18% decrease in discharge to death since program inception. Based on these metrics, administration felt that branching out the palliative care program would result in further improvements in patient and family satisfaction and even greater impact on cost avoidance, readmission and death statistics. The challenges have been both anticipated and surprising. We expected to face educational and culture change issues in the outpatient and nursing home settings and they were and continue to be significant. Growth, however, has been rapid in both the nursing home and outpatient sectors. Due to physician demand there is also an inpatient palliative care unit in development as well. Staffing has posed a significant challenge due to rapid growth. We have tried to maintain our staffing at 1.0 F.T.E. per 10 patients on our average daily census. Prior to the start of the outpatient, nursing home and home care initiatives we were at ten FTE’s for an average daily census of approximately 110 patients. In anticipation of our growth we added a total of three 1.0 FTE’s (A full time ARNP, social worker and physician) who are hired and currently being trained and oriented.
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