A Novel Approach to Outpatient Palliative Care Clinic Flow

Topic: Palliative Care Models by Setting

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Hospitals and healthcare organizations are embracing outpatient palliative medicine to complement and expand upon the work that is often started during an acute care palliative care consultation. Earlier palliative care consultation and integration in the outpatient setting can decrease hospital cost expenditures and improve patient experience and overall quality of life (2014 Institute of Medicine (IOM) Report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.  Key findings regarding financing healthcare near the end of life, National Consensus Project (NCP) for Quality Palliative Care. (2013).  Clinical practice guidelines for quality palliative care, 3rd edition. Accessed March 6, 2016 from http://www.nationalconsensusproject.org/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf). Different models of care are currently being utilized, including clinic-based and home-based models.

Similar to palliative care in the hospice or inpatient setting, the use of a multi-disciplinary team in the outpatient setting is a crucial component in allowing for full assessment and management of the four corners of wellness – physical, social, psychological and spiritual. The practice of palliative care is fundamentally dependent on the multidisciplinary team; however, as outpatient palliative care clinics continue to grow, there can be a struggle to maintain the multi-disciplinary model for various reasons including the mismatch between the traditional clinical template, needs of a palliative care patient and the multidisciplinary team itself.  Recent research indicates that quick, minimal-style palliative care consults can actually cause more harm to patient good, indicating that developing relationships over time and leveraging the MDT is crucial to our work (Carson SS, Cox CE, Wallenstein S, et al. Effect of Palliative Care–Led Meetings for Families of Patients with Chronic Critical Illness: A Randomized Clinical Trial. JAMA. 2016;316(1):51-62).  As outpatient palliative care becomes more integrated and accepted in routine patient care, the demands of volume and time can make it challenging to incorporate the multidisciplinary team, creating the temptation to abandon the multidisciplinary team and the four corners of wellness. We will share our own challenges and successes since establishing a 5-day per week ambulatory palliative care clinic in Stanford Cancer Center, a tertiary academic medical center. As our patient volume has grown, we have implemented a unique approach to scheduling patients which has allowed for us to maintain a full multidisciplinary approach, including LCSW, chaplain, nursing and physician.  Since implementation, we have been able to meet patient demand, decrease wait time from initial consultation, improve clinic flow and enhance team wellness and job satisfaction.

 

Author

  • Joshua C. Fronk, DO
  • jfronk@stanford.edu
  • Stanford Health Care
  • 300 Pasteur Drive
  • Stanford, CA 94305
  • 650-724-0385

Co-authors

  • Elizabeth Boatwright
  • Gary Bertuccelli
  • Gayle Humphrey
  • Heather Shaw
  • Jeong Min Jung
  • Karla Schroeder
  • Kavitha Ramchandran
  • Lisa Gustofson
  • Sandy Chan

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