Hospitalists: Strategies for Caring for People with Serious Illness
In the busy day of a hospitalist, one or two complex patients can lead to a backlog in daily rounds, delayed discharges, and inadequate time to communicate with patients and families. Palliative care, named as a core competency for hospitalists by the Society for Hospital Medicine (SHM), aims to improve quality of life for patients and families living with serious illness and complex need through skilled communication, pain and symptom management, and care coordination.
For many patients, hospitalists are in the best position to manage symptoms and have conversations about care priorities. Clinical training allows hospitalists to efficiently address common gaps in care for people with serious illness. For patients with the most complex needs, earlier palliative care consult leads to improved patient outcomes, improved clinician satisfaction, and reduced hospital utilization and costs.
Visit SHM's Resource Room for Palliative Care to access additional resources specific to hospital medicine strategies and hospitalists.
Download a course catalog with information about continuing education credits and ABIM MOC credits for all CAPC courses here.
What’s in the Toolkit
Why Does Palliative Care Matter for Hospitalists?
Learn how palliative care can help both patients and hospitalists.
The value of skills training for hospitalists.
CAPC courses and tools for hospitalists.
Journal of Hospital Medicine, December 2017.
Journal of Hospital Medicine, June 2018.
Journal of Hospital Medicine, December 2018.
Identify Gaps in Care for Seriously Ill Patients
Training in core pain and symptom management, communication, and care coordination allows hospitalists to efficiently identify and address common gaps in care for people with serious illness and to refer patients to palliative care when appropriate.
An introduction to palliative care, how it is delivered, its impact on quality of life, and the growing population of patients who need it.
Validated instrument to assess pain intensity and impact on function over time.
Brief (4-question) screening tool for anxiety and depression.
Measure for assessing generalized anxiety disorder.
Tool to assess pain in cognitively impaired patients.
Stages of cognitive function for those suffering from a degenerative dementia such as Alzheimer's disease.
Adapted from the Opioid Risk Tool questionnaire developed by Lynn R. Webster, MD to assess risk of opioid use disorder. This adapted version uses currently recommended terminology, for example ‘opioid use disorder’ and ‘substance use disorder’.
Toolkit for finding the right patients at the right time to address gaps in care.
Improve Communication
According to SHM's Core Competencies in palliative care, all hospitalists should have the skills to:
- Lead culturally sensitive communications with patients, families, and colleagues about prognosis and goals of care
- Provide counseling on advance care planning and alignment of care plans with patient preferences
Clinicians hoping to improve their communication skills or clinical champions positioned to improve staff competency in serious illness communication should refer to SHM's Improving Communication about Serious Illness Implementation Guide.
Techniques for communicating with patients and caregivers about their serious illness and eliciting patient hopes, fears, and priorities for care.
Assessing and supporting caregivers of people with serious illness.
One-door portal for clinician communication skills training.
Coordinate Care
According to SHM's Core Competencies in palliative care, hospitalists are expected to coordinate goals of care and the treatment plan among the treating team, including primary care physicians and specialty consultants.
Checklist of triggers for referral to a specialty palliative care team.
Manage Pain and Other Symptoms
Hospitalists are often called upon to provide first-line treatment for pain and other symptoms, including nausea, vomiting, dyspnea, delirium, and constipation.
Conducting a comprehensive pain assessment to guide safe and effective treatment.
Integrating routine risk assessment for substance use disorder when considering or using opioid therapy.
Designing a safe and effective opioid trial for the patient with serious illness.
Ongoing evaluation of opioid benefits, risks, and side effects for the patient with serious illness.
Safe opioid prescribing for patients with serious illness, using the Federation of State Medical Boards (FSMB) Guidelines for the Chronic Use of Opioid Analgesics.
Opioid pocket reference for providers including safe starting doses, equianalgesic chart, and standard dosing strengths.
Validated instrument to assess pain intensity and impact on function over time.
Adapted from the Opioid Risk Tool questionnaire developed by Lynn R. Webster, MD to assess risk of opioid use disorder. This adapted version uses currently recommended terminology, for example ‘opioid use disorder’ and ‘substance use disorder’.
Training curriculum and clinical tools for assessing and managing five common symptoms in patients living with serious illness.
Brief (4-question) screening tool for anxiety and depression.
Measure for assessing generalized anxiety disorder.
Research review for clinicians caring for hospitalized patients living with serious illness. Journal of Hospital Medicine, 2018.
Deliver Quality Care Transitions
Ensuring that hospital discharge plans are honored requires communication about care plans with primary care and other outpatient providers, as well as community services.
Assessing and supporting caregivers of people with serious illness.
Practical tool for assuring safe discharge for patients living with serious illness.
