Creating a Palliative Care Service in a Community Hospital

Topic: Palliative Care Models by Setting


Creating a Palliative Care Service in a small, community hospital is a challenge.  Patient volumes may be low making the allocation of expert staff and other resources a secondary priority.  Houston Methodist St. John Hospital, a 177 bed community hospital, part of the Houston Methodist System was able to successfully create, sustain and grow such a service over the past five years by building on the credibility of a few key staff members. Initially, a half time RN position was allocated to develop and run the program.  An ICU RN with interest in palliative care was selected as the director and completed formal training.  She garnered support from the Chief Nurse, the Chief Executive Officer and the Chaplain.  The credibility and expert communication style of the director led authority to the emerging program.  Physicians respected her assessment of patient need and recommendations for plans of care.  She slowly enlisted the participation of other intradisciplinary staff and enrolled them in formal training.   A Chaplain and Speech Therapist began seeing patients in addition to their usual responsibilities.  Over time, a pharmacists with expert advocacy skills, a social worker in the case management department with knowledge of community services, became involved.  Team members began meeting one on one with physicians regarding services.  The program was formalized with a strategic plan, creation of patient and staff educational programs and the implementation of a patient needs assessment.  Two private, palliative care trained physicians serve as resources for the service and the attending physicians.  The original director now serves in a full time capacity and has a staff of two Registered Nurses in addition to the intradisciplinary team members that serve from their home units.  To capitalize on resources, this team also serves as patient liaisons and manages patient and family concerns.  The metrics validate the success of this service; the volumes have grown year over year with a 6.6% palliative care penetration (quartile 4 of 2014 CAPC data base).  The mean annual initial inpatient visits per FTE also is in the fourth quartile.  The LOS pre palliative care consult exceeds the fourth quartile, indicating the acceptability of this service and is a testament to the talent and skill of the team members.  Consult to discharge and total LOS also exceed the fourth quartile. In summary, the power of one, credible, passionate leader with the ability to enlist and engage others can develop a successful service utilizing the resources at hand. As success builds upon success, the growth of the service occurred and is leading the benchmarks with its outcomes.  Such a service is not typical of a small organization, yet the impact on the quality of patient care and LOS is significant. 



  • Cynthia Broussard, RN
  • Katherine Walsh, MSN, DrPH, RN, NEA_BC

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