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Hospital and Hospice Partnerships

Next Reply: Re:Hospice &/or Palliative Care referral?
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Post Hospice &/or Palliative Care referral?
Author: KateDronkowski
Date: Feb 19, 2009 10:42 pm
I am an RN hospice coordinator in a hospital. Our hospice program is a hospital based based program that has both PC and Hospice services. The PC and Hospice physicians are one in the same. Do you require that every inpatient that is a hospice or potential hospice referral have a palliative care consul/referral first? If this is your practice, why? (please elaborate) If not, are there any guidelines your physicians follow?
Thanks you- Kate Dronkowski RN
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Re:Hospice &/or Palliative Care referral? (by mrabow on 02/24/2009)
It is not necessary that every hospice patient be seen by palliative care. In fact, it might be wise to try to distinguish the 2 services as much as possible. If referring clinicians see the pc service simply as "pre-hospice," they are less likely to make other kinds of referrals. The PC service will have difficulty moving "upstream," seeing patients earlier during the course of illness or earlier during the hospitalization. A robust pc service will have a diversity of referrals, including both chronic and terminal illness, symptom management, communication, and goals of care referrals. Best, Michael W. Rabow, MD, Associate Director, UCSF Palliative Care Leadership Center
Re:Hospice &/or Palliative Care referral? (by AmberBJones on 02/24/2009)
Local circumstances appear to dictate the answer to your question. I do not know of any programs that require a palliative care consult for every hospice patient(or potential hospice patient). However, if a patient's eligibility for or acceptance of hospice is unclear, either a palliative care or a pre-hospice consult may be appropriate.

In several sites with which we are familar, physicians who assume both palliative care and hospice roles have done a fine job educating referral sources about when and how best to use them by being readily available, clear about the benefits and constraints of both the palliative care and hospice service models, and willing to accept referrals for either/both. For example, when a referring doctor is hospice-averse or unclear about a patient/family's goals of care, a pallative care consult often works well and may or may not ulitmately lead to a hospice transition. Or when a hospice referral is made but the patient is either not eligible or does not chose to elect hospice care, palliative care may be the most appropriate intervention. Or - as is often the case, a palliative care provider can help facilitate the hospice choice when it is the best option.

The combination of roles you describe presents yout physicians with a unique opportnity to encourage/support decision-making focused on getting the right care to the right patient at the right time.

I have not seen guidelines specific to these circumstance. However, other resondents may have language to share.

Amber B. Jones
CAPC Hospice Liaison Consultant

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