Hospital and Program Description

North Memorial Medical Center is a 518-bed level I trauma center, which is also certified as a primary stroke center and offers air service for transporting major trauma victims. Palliative care services are located in the hospital and consultants consist of one physician and nurse practitioners. Palliative care services consist of in-patient consults, home care, and outpatient consultations.

Problem

Patients are subjected to aggressive treatments, suffer from intense pain and anxiety, while already having been given a terminal diagnosis. These patients are not being given an early consultation referral for palliative care as an alternative/adjunct to such aggressive treatments.

Processes to Resolve Problem

The palliative care consult team is in attendance at ICU/medical rounds and at hospitalist meetings on a daily basis, reminding them of palliative referral and offering palliative services to their patients while they stay on other units. The palliative consult team reiterates to patient’s medical team that palliative care is available in parallel to the care the patient is already receiving. Referral to palliative care is not a hopeless event but a longitudinal process. It is absolutely made clear to providers and patients that the primary provider guides patient care and treatment, thus avoiding conflicts of interest between providers, and avoids leaving patients feeling abandoned.

Outcome

The referrals for palliative consult have been expedited. Patients with terminal diagnosis, whether cancer, heart failure, respiratory failure, or Alzheimer's disease, are referred for palliative consultation while they remain on their current non-palliative unit. The palliative care team makes daily visits to assess pain, anxiety and delirium level and treat accordingly, while patients receive other medical treatments or await discharge to the palliative unit or home palliative services. This arrangement has increased awareness among other providers of the palliative care team and the supportive role they provide, which not only eases their burden but also make their patients more comfortable.

Lessons Learned

By providing supportive parallel services to primary providers, the palliative care team alleviated primary physicians’ fears that they would lose control over their patients’ care and eased their burden of care by making patients more comfortable.