Center to Advance Palliative Care

One of the reasons that palliative care services provide an excellent resource is the continuity provided by the palliative care team compared to a continually shifting hospitalist service. As medical director of our relatively small service for palliative care I do provide an advantage in knowing the family and the clinical history often even better than the hospitalist who rotates off each week. However, I must tell you I have anxiety when it comes to thoughts of decreasing the LOS for the ICU when we are a small hospital system and a number of the cases have been incredibly stressful, incredibly lengthy, gut-wrenching cases with prolonged ventilator care, unrealistic family expectations (inspite of numerous family meetings explaining prognosis and poor quality of life), nursing frustration and burnout, etc. I KNOW I have helped in a number of much shorter stays where everything went well and palliative care really did work. But it's the FEW cases with incredibly long lengths of stays and bioethical dilemmas that remain at the forefront of my and everyone else's thoughts. I do believe the palliative care service is appreciated (our first real survey is just going out) but sometimes numbers might not reflect it (ala LOS.) Terrell B. VanAken, M.D., Medical Director, NorthBay Bridges/A Palliative Care Service of NorthBay HealthCare.