Transcript Palliative Care Consultation Team

Palliative Care Consultation Team
An Introduction
Basics of Pain Management
11.30.09
What is Palliative Care?
What is Palliative Care?
• One definition:
• “comprehensive, interdisciplinary care, focusing
primarily on promoting quality of life for patients
living with a serious, chronic, or terminal illness and
for their families…assuring physical comfort and
psychosocial support. It is provided simultaneously
with all other appropriate medical treatments.”
• Billings, J Palliative Medicine, 1999
• California HealthCare Foundation
• Spreading Palliative Care in Public Hospitals
Initiative
• Focus on providing culturally sensitive care
• We have one of six implementation grants
statewide
California public hospitals lag private
hospitals in palliative care
Palliative Care Programs 2007, by Hospital
Ownership
70%
60%
50%
40%
30%
20%
10%
0%
Non-profit
District
City/County
Percentage of hospitals with programs
For-profit
CCRMC data
• Review of data from patient deaths, January June 2009
• How many patient deaths after > 30 days in
the hospital?
• In which unit do most patient deaths occur?
• What are the major causes of death among
our patients?
Length of stay for patients who
ultimately died
Length of Stay Prior to Death
60
Number of Days
50
40
30
20
10
0
1
5
9
13 17 21 25 29 33 37 41 45 49 53 57 61
Patients
Location at time of death
Patient Location at Time of Death
FLOOR
33%
CCU
52%
IMCU
15%
Causes of death at CCRMC,
January-June 2009
Reported Cause of Death
Septicemia
19%
7%
Acute Respiratory
Failure
Liver or Renal
failure
Malignancy
7%
COPD
29%
15%
10%
13%
Acute MI
Other
The CCRMC Palliative Care Consultation
Service
• A multidisciplinary team which will
collaborate with CCRMC staff in providing
palliative care to our patients
• An integrative service
• Available for inpatients in our first year
• Expanding to the ED in our second year
Multidisciplinary
• Clinicians (Hellman-Wylie, Steinhart, Freedman, Akin, Tzvieli,
Kuruvilla, McCormick…and you?)
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Social work (Linda Russell)
Pharmacists (Katherine Dial, Sharon Sihota)
Interpreters
Psychiatry consult-liaison staff (Liat Porat, John Echols)
Nursing education (Marianne Bunce)
Residents (Matt Foster, Sergio Urcuyo)
• Any resident on elective block who wants to join us for
consultations is welcome
When do I consult?
• Terminal illness with distressing symptoms
• Chronic illness with distressing symptoms
• Patient/family prefer to be at home rather
than hospital
• Prolonged critical care course with poor
prognosis
• Lack of clarity in goals of care
When do I consult?
• Chronic illness with frequent hospitalizations
• Patient/family lack understanding of diagnosis and
prognosis
• Advance care planning - choosing a DPOA,
completing an advance directive
• You just don’t have time to find out what is going
on….
What will we do?
Review referred cases and arrange family meetings
Support relationship of primary team with patient and
family
Explore social history
Review current medications and other orders
Establish advance directives
Arrange home or hospice services
Co-follow patients with you
Our Challenges
• Palliative care for an ethnically diverse
population
• Integrative care - effective collaboration
between two teams
• Education throughout the institution nursing staff, residents, and others
Attitudes toward care at the end of life vary by race
and ethnicity
• CHCF sponsored survey of 1,800 California
adults in 2006
• Which comes closer to your view?
– “Doctors and nurses should always do everything
possible to save a life.”
– “Sometimes there are circumstances where a
patient should be allowed to die.”
Attitudes toward care at the end of life vary by race
and ethnicity
70
Allow death
It depends
Do everything
60
50
40
30
20
10
0
White
Latino
AA
Asian
Culturally appropriate palliative
care
• Interpretation - Interpreters trained to act as
cultural brokers, not simply translators
• Cultural humility
• Strength of provider-patient therapeutic
relationship key to navigating gaps in
understanding
Our Challenges
• Integrative care - effective collaboration between
two teams
– Primary team included in meetings whenever possible
– Encourage residents to lead meetings
• Education throughout the institution - nursing staff
and other disciplines
– Inclusion of the bedside nurse in meetings with patients
and families.
– Continuing education sessions for nursing staff
– Educational programs with other disciplines? (RTs, etc.)
• Palliative care team is available Monday Friday, 8 am - 5 pm
• Call schedule available on amion.com with
password “ccrmc”
• Think of palliative care broadly, not just in
terminal illness
• We will learn as we go - please give us
feedback so that we can do just that