Palliative Care Chaplaincy Coverage Based on Source of Data and Degree of Chaplaincy Support
Introduction: The Palliative Care Team at a 700 bed academic medical center has included a Chaplain at 0.4 FTE since mid 2016, though there was a lapse of 2 months without a Chaplain at the end of 2017. Increased Chaplaincy support for Palliative Care began July 2, 2018. Though the clinicians attempted to keep track of which patients received Pastoral Care from the Palliative Care Chaplain on the Palliative Care Quality Network (PCQN), the average recorded patients per week, 5, was lower than the team recognized was likely truly occurring.
Objectives: Develop an understanding of the number of patients seen by Chaplaincy for 2 weeks, 1 week while Chaplaincy support was 0.4 FTE on the Palliative care team, and 1 week when the support had increased by 50%.
Methods: We intervened in two ways: (1) The clinicians recorded number of patients they requested chaplaincy visits of our part-time Chaplain on their daily billing sheets for a week and (2) the Palliative Care Chaplain recorded for a week how many Palliative Care patients he saw and how many Palliative Care patients he negotiated other Chaplains to see. We collected the above data both before and after the change was made from 0.4 to 0.6 FTE.
Results: We found that the clinicians underreported in PCQN for that week, citing only 1 patient who was seen by the Palliative Care Chaplain. The handwritten tally did help the clinical team to report more accurately how many patients were seen that week: 11 total visits, 2.2 per day on average. The Chaplain had kept track of hours spent taking care of Palliative care patients, not the number of patients seen. He spent 1.75 hours per week in direct patient care and facilitated 1.25 hours of other chaplains seeing our patients, for a total of 3 hours. If the visits are approximately 0.25 hours in duration then this equals about 12 visits for the week. When the Palliative Care Chaplain’s dedicated time increased, there were 4 patients recorded in PCQN who were seen by the Palliative Care Chaplain during the recorded week. The Palliative Care clinicians recorded on a separate tally 25 total visist, 5 visits per day on average. The Chaplain himself recorded seeing 23 Palliative Care visits, plus 15 more visits conducted by other Chaplains whom he coordinated for Palliative Care patients.
Conclusions: These data were collected as a means of showing the need for Chaplaincy visits amongst Palliative care patients, but more importantly that the team is under reporting Chaplaincy coverage in the one routine data collection source that is in use for quality improvement. Only a fraction of the actual care being given by the Chaplain was being reported on PCQN.
Implications: With this small intervention and change in data collection, a more accurate representation of pastoral care for the Palliative Care patient census was shared with the hospital administration, making a case for increased Chaplaincy support for the Palliative Care team.
Christina E. Fitch, DO
Baystate Medical Center
759 Chestnut Street
Springfield, MA, 6093