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Palliative Care In Action


Palliative Care In Action Bridging Gaps in Care Martha L. Twaddle MD, FACP Medical Director, PCCHNS Assistant Professor of Medicine Director of Palliative Care – PowerPoint PPT presentation

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Title: Palliative Care In Action

Palliative Care In Action Bridging Gaps in Care
  • Martha L. Twaddle MD, FACP
  • Medical Director, PCCHNS
  • Assistant Professor of Medicine
  • Director of Palliative Care
  • Rush Medical College
  • Evanston - Northwestern University School of
  • President, The American Academy of Hospice and
    Palliative Medicine

  • Center to Advance Palliative Care
  • Mount Sinai School of Medicine
  • 1255 5th Avenue, C-2
  • New York, NY 10029
  • 212-201-2670 office
  • 212-426-1369 fax
  • 212-201-2680 event line

A national initiative supported by The Robert
Wood Johnson Foundation at the Mount Sinai School
of Medicine.
Case Study - Rose
  • Consult called by Internist big picture needs
  • I hope we can keep her alive
  • Refractory pneumonia, myelodysplasia
  • Provided significant psychosocial support
  • Patient articulate of illness and sense of
    prognosis, 92 yo husband NOT!

Palliative Care
Modern Medicine
Case Study - Rose
  • Palliative Care Service
  • Consultation Team
  • Followed Rose for several days while receiving
    continued disease modifying treatments
  • Much time spent with family clarifying and
    supporting goals of care.

Palliative Care Consult
  • Reimbursements
  • MDs of same specialty can see a patient on the
    same day if they link their charges to different
  • Primary MD ? Primary Diagnosis
  • Consultant in Palliative Care ? Symptoms

Palliative Care Consult Team
  • How do we learn?
  • Post-graduate MDs traditionally learn practical
    knowledge through consultation
  • How do we facilitate communication?
  • Consultation provides give and take
  • Forges relationships and networking
  • How do we build support?
  • For patients families
  • For the professional caregivers
  • MDs, RNs and other staff

Palliative Care Consult Team
  • Additional goals
  • Education disseminating information
  • Diffusing tensions and intensity
  • The blessing of the second opinion
  • Spreading the support for patients and families
  • Supporting the professional caregivers
  • Affirming the Art of Caring

Giving Shape to the Opportunities
  • Palliative Care Service
  • Consultation Team
  • Inpatient Unit
  • Hospice Unit
  • Palliative Care Unit
  • combo
  • Scatter Beds

Admission to Inpatient Hospice
  • Admission
  • Physician ? Palliative consultation
  • Like the Rehab model
  • From hospital, home or nursing home
  • Discharge/readmit - nonDRG
  • Relatively short ALOS

Scatter Beds
  • Much more challenging given the variable of
    nursing support
  • Multiple contractual relationships
  • Direct admissions within hospital
  • Discharge/readmit for Hospice GIP
  • Team-oriented care
  • Enhancement of care in familiar setting

Case Study - Rose
  • Transferred to the Hospice IPU
  • The Intensive Caring Unit
  • Aggressive Palliative Care (beyond scope of other
  • Intensive End-of-Life Care
  • Stabilization
  • Transition to another site of care

Relationships with Physicians
  • Consult Model is key
  • Think the Rehab model
  • Collaboration and support
  • Enhancing their care of their patient
  • Enlarging the circle of support not replacing
    but expanding the concept of team!

Role of Medical Director
  • Hospice Med Directors should be Consultants in
    Palliative Medicine
  • Educators in the field
  • Intensivists in End-of-Life Care
  • Liaison with Interdisciplinary team

Integrating the Interdisciplinary Team
  • Consult Model
  • Formal Team discussion of cases before or after
  • Quarterly meetings with Hospital Administration
  • Minutes
  • Action plans
  • Quality Assurance

Impact on the Culture of the Hospital
  • Hospice and Palliative Care are not soft
    alternatives or a consolation prize!
  • Enhanced understanding of Hospice Palliative
  • Affirmation of professional caring
  • Diffusing stress
  • Support for families and professionals
  • Enhanced Wellness

Impact on Patient Care
  • Best Practices
  • Outcomes
  • Pain and Symptom Control
  • Average Initial VAS at consultation 7
  • 24 hour follow-up 2
  • Cost appropriate utilization

Continuum of Services
  • Any Stage
  • HomeCare
  • Community Outreach
  • Mobile Medical Unit
  • Personal Care Assistance
  • Palliative Care Consult Program

Case Study - Barbara
  • Followed for over 2 years in Ambulatory setting
  • Very clear of goals of care
  • Unexpected decline during and after XRT
  • Admitted to Home Care
  • Transitioned to Medical Home Visits

Case Study - Barbara
  • Improved seen as MD home visit
  • Declined again admitted to Hospice InPatient
  • Home briefly with Hospice Home Services
  • Re-admitted to IPU and died approximately 10 days

Advantages to Continuum
  • Brings Services to the Community Level
  • Provides services in the right setting
  • Meets Patient Needs
  • Increases Patient Choice
  • Increases Patient/Family Satisfaction