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CAPC Palliative Care Discussion Forum
Pediatric Palliative Care
24 Hour Pediatric Palliative CareAuthor: Triley
Date: Jan 12, 2012 5:03 pm
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There are, in fact, many hospital-based pediatric palliative care consultation programs/services that are in various phases of development around the country. Many of the larger, more developed programs are available off-hours. Some of the smaller programs are as well, though it's often less formal. As programs are developing, it is possible to have a small number of people willing to take calls after hours. But over time, that can become problematic as your numbers grow. The important thing is to set up a system that is sustainable and doesn't depend on committed people who can burn out or may be unavailable at times - you don't want to promise something you are unable to deliver.
I will share with you the details of our service, but know that it's an n of one:
In our program, we are available 24/7 - we make in-house rounds every day and can be called for phone advice or to be called back in for significant issues. Obviously, this ability to be present requires a different level of staffing than simply taking phone calls. The way our call system works is that an MD or NP (with MD back up) is on call every evening and weekend. They are not compensated separately for call responsibilities as that is part of their job description. We also have a psychosocial team member on call along with the medical provider. Those folks rotate call (chaplain, child life specialist, bereavement coordinator, case manager, psychologist, social workers) for a week at a time. They are not compensated for taking phone calls but are paid their hourly rate if they do come back in to the hospital.
The primary reasons for referral are many - and mirror most of the common reasons for palliative care consultation. We get consulted quite a bit for family support, care coordination, decision making/goals of care clarification or elicitation (both end of life and otherwise), symptom management (pain and other symptoms), management of the active dying process, anticipatory grief/bereavement, etc.
If you're interested in talking more specifically about your program, please contact me at sfriebert@chmca.org or you can contact the other pediatric PCLC, Children's of Minnesota.
Thanks!
Sarah Friebert
I work in pediatric palliative care in Vermont and we currently have two services available to us, one through Dartmouth Hitchcock Medical Center and one through Fletcher Allen Health Center. DHMC has had a service for approximately 7 years, where as FAHC is still relatively new. They utilize telemedicine when possible. They've even skyped with nurses in families homes at times, which is free and a great way for someone to eye ball a patient when they can't be present. In my experience, both hospitals have been extremely willing to help other rural areas create hospital-based consultations services, so I'd encourage you to reach out to their palliative care teams if you'd like more information.
Best, Monica
I didn't see a response about how many off-hours consults (by phone and coming into the hospital) you support? What patient census or population metrics have you found fit your on call model?
Linda