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CAPC Palliative Care Discussion Forum
General Operational Topics

Next Reply: Re:Physician referrals
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Post Physician referrals
Author: rkozyckyj
Date: May 18, 2010 8:08 am
need input from colleagues.
Our large teaching hospital is re-examining the way consults fro Palliative Care are initiated. One of the proposals involve allowing nurses to call for a consult, then after chart/caser review the Palliative Care consultant is to call attending to ask if a consult is needed. Seems circuitous. Looking for others' experiences
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Re:Physician referrals (by SharolHerr on 05/18/2010)
That does indeed sound circuitous. As a cardiologist would not call the attending for a consult, it would seem no more appropriate for the palliative consultant to call the attending. The staff nurse, case manager, etc. should be the one contacting the attending to suggest that a palliative consult would be appropriate. For our team to review the case requires a consult. The option of curb side conversations between the PC doc/APN and the attending is not uncommon prior to the order being given by the attending. By educating the staff nurses and case managers you will develop wonderful advocates for palliative consultation.
You will also want to steer away from case finding by your team. Routine processes such as participating in unit rounds have been used by some programs, particularly in the ICU. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
Re:Physician referrals (by Deb on 05/18/2010)
It may be circuitous, but sometimes more effective. I have asked case managers and nurses to call me if they think a pt is appropriate and I will review, and call the attending if the pt is appropriate. The reason is that, in spite of education, the nurse or case mgr still can not always tell the attending how palliative care can help, and remind the attending that we are not hospice, because often they will say "oh, they are not ready for that yet..."
Re:Physician referrals (by cblizzard on 06/06/2010)
At our hospital ANYONE can ask for a palliative care consult; MD, nurse, family, RT etc. Someone from our team (social worker, RN, APN) will go by, look at the chart briefly, support the Staffer who asked for the consult and put a very brief note on the chart in the physician's notes stating a palliative care consult had been requested, what we might be able to help with and an invite to the attending to call us if he/she would like our assistance. We check back the following day and again support the staff if no consult has been ordered by the physician. We cannot see the patient without the attending's order but we can help the staff with what to say to convince the MD.
C. Blizzard, MD
St. Luke's Episcopal Hospital
Houston
Re:Physician referrals (by sjcrump on 06/10/2010)
I have experienced several different models, including working at St. Luke's. Generally, I think there should be only one type of consult. It should be physician involved and physician requested. I think palliative IDT members should be available to discuss issues and cases with hospital staff and give education and support to the staff member; however, a patient encounter should not happen without a formal consult from the attending physician. Likewise, "case finding" and trigger methodologies should be used for case review and education of the staff, system, and IDT. A palliative care consult should not occur without attending request. Trigger methodologies could with great care be used to prompt attending if they want a palliative consult or not.

S. Joyce Crump, Program Manager, on behlf of Ryan Nash, MD, Assistant Professor - UAB Center for Palliative Care
Palliative Care Leadership CentersTM
University of Alabama at Birmingham

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