Bristol Myers Squibb Children's Hospital Description

Bristol-Myers Squibb Children's Hospital is a 100 bed Acute Care Facility that first opened in March 2001. The Pediatric Advanced Comprehensive Care Team (PACCT) came into being solely on the creative ingenuity of the staff members who worked in the Division of Pediatric Hematology/Oncology. Nursing research has long documented that continuity of patient care significantly improves patient outcomes. This paradigm was only defined and considered within the confines of the "hospital setting". In the realm of palliative care and hospice care, the staff realized that significant impacts could be made in continuity of care if the same health care providers would be the ones that cared for patients in their homes. The PACCT team is comprised of nurses, APNs, counselors, primary oncology physicians and a board certified palliative care physician.

Description of Topic

The collective thought of the Pediatric Oncology Nursing Division was that we had the expertise to care for patients needing palliative and hospice services. The idea being that we would meet and get to know children and their families at the time of diagnosis, caring for them in the inpatient setting and then visiting them in their home for follow ups. This way there is no need for "external" agencies (many who admit to having no or very limited pediatric experience) and thereby maintaining the continuity of care. Feedback from families has told us that when hospice services are needed for their child, it was unsettling to have a whole new team of caregivers at a time when what they really needed and wanted was the consistency of care from the team most familiar with their child, treatment regimen and family. We had the team of pediatric health care providers at the ready with all the expertise to provide care in the home but not the monetary resources to make it happen. We applied for grant funding and secured 150K annually to pilot the program for 3 years.

Impact on Program

: The PACCT program eases the transition from hospital to home. It is family centered and designed to improve the communication between patients and a multidisciplinary team of caregivers. Having a hospital staff member and a member of the pediatric oncology medical team caring for the patient at home enhances communication with everyone familiar with the patient's plan of care. It also makes it possible to act quickly to provide adequate pain control and symptom management.

With children, treatment can continue to be aggressive and carry on until the child is cured or dies. Parents often wish to give their child every available treatment option to reach a cure or extend their child's life. Children are often referred to hospice at the very end of life due to the fact that hospice limits curative therapies. PACCT offers support and care at the end of life by allowing families to remain with the health care providers whom they and the patient already have an established trusting partnership. This approach to care provides much needed support at end of life.

Since its inception in 2003, The PACCT program has completed over 1400 home visits. The total number of patients to date enrolled is 136. 34 patients had pain free deaths either at home or in the Pediatric Oncology Unit. None the patients died in a pediatric intensive care unit on ventilator support.

Lessons Learned

The challenges of transitioning from a grant funded pilot program to full fledge revenue generating service is being solved via the collaborative effort between the hospital department of budget and reimbursement and nursing. We are actively negotiating service contracts with insurance payers to be reimbursed for this type of care. Clearly this program is fiscally attractive to insurance payers because it can decrease the LOS due to immediate follow up at home as well as manage pain and symptoms in the home. It is infinitely better for the patient and family as it allows them to stay and be supported in the familiar home setting. Additionally, the pursuit of grant opportunities remains a financial option as well and we are actively working with hospital grant writers to secure additional funds.

Genesis for the PACCT program came directly out of the evidenced based practice research that determined "Continuity of Care" enhances patient out comes. The nursing staff of the Division of Hematology/Oncology @ the Bristol-Myers Squibb Children's Hospital realized that in chronic and life threatening illnesses such as cancer this continuity would better serve patients and their families if it continued through out the trajectory of the illness, inpatient unit, outpatient and home, through cure or end of life.

Continuity of care along the chronic illness continuum has improved medical and nursing care by providing a seamless transition from one care area to another. Care is exquisitely coordinated through out the illness because it is the same team of caregivers providing care. This coordination of care is a direct out come of enhanced communication of all caregivers in concert with the patient and family. "Communication reduces patient suffering and helps parents feel more prepared for child's end of life experience" (Wolfe 2007).