Center to Advance Palliative Care

I'm sorry to hear you're burning out.

I am not aware of data that compares different kinds of teams, but there are several consensus statements in the field at this time that point to the need for physician involvement on a multi-disciplinary team. See the NCP website at http://www.nationalconsensusproject.org/ and the article by Weissman et al., "CAPC PC Service Metrics" J Palliat Med. 2008 Dec;11(10):1294-1298. In some institutions there is a physician-centric culture where recommendations from NPs don't carry as much weight, and if that's the case in your hospital then you may not be maximizing your possible clinical impact in your current model.

LOS is a non-starter; you need to reframe their expectations regarding LOS. As you indicate it's something you can document for a given case (good symptom management and discharge planning can help to expedite safe & appropriate discharge for survivors in some cases) and such a vignette or case-study can be pretty compelling. But it's practically impossible for you or any other PC program to quantify any LOS impact, as we summarized in a recent article in JPM (see J Palliat Med. 2010 Jun;13(6):761-767.).

However it is definitely possible to demonstrate cost reduction across your whole case load, and to quantify that in dollars. You need to partner with a financial analyst in your hospital and match your PC consult list to the hospital data to quantify the cost-reduction that your program produces, comparing before and after costs per day per PC patient. This is done using your own actual hospital data, not just guesstimating the effect based on the CAPC calculators. One of the CAPC online (e-learning) resources (http://campus.capc.org/) gives you some instructions for how to analyze the data, and it's something we cover in great detail in a PCLC training (any level - core, consult or custom) which includes one year of post-training mentoring. See http://www.capc.org/palliative-care-leadership-initiative/overview

Such a financial analysis is often sufficient to prove that the hospital is seeing a sizable financial benefit secondary to you'all helping to improve care for the patients you see, and helps to make the case for sustaining and expanding the program to meet the existing and potential needs.

Please do let me know if this reply helps or falls short. We can't afford as a field to have people like you burning out and leaving!

- Brian Cassel
VCU Massey Cancer Center
Palliative Care Leadership Center