Center to Advance Palliative Care

I agree with everything Sharol said and only add that timeliness in providing PC or hospice care was one of the few domains in which we do not seem to be doing well, as a field. Diane Meier's audio-conference on "Quality Measures 101" a year or two ago, points this out quite dramatically, with a median of 18 days elapsing at Mt Sinai. In the Morrison et al. study (which Sharol cited in her reply), cases were excluded which had a LOS of less than 7 days because of how unlikely it was for patients to receive a PC consult in the first week. In the Twaddle et al. study of academic medical centers, PC consults occurred on average 9 days after admission (if at all). In this context, "earlier" referral would be anything less than a week!... Brian Cassel, VCU PCLC, 804-628-1926, jbcassel@vcu.edu