Growth of an Academic Palliative Medicine Program: Patient Encounters and Clinical Burden

Abstract

Objectives Our aim is to describe the growth and staffing structure of a palliative care program at a comprehensive cancer center. Methods During fiscal years (FYs) ending in 2000 through 2010, we recorded all billed palliative care consultations and follow-ups. In order to determine the yearly clinical burden per physician, advanced practice nurse (APN) and physician assistant (PA), we calculated the mean number of patient encounters per clinical full time equivalents. Increase in absolute number of patient encounters and relative (%) growth from year to year were calculated. Results Over the 10 year history of the program, the number of outpatient consultations tripled while inpatient consults increased from 73 to 1880. In all cases, with the exception of the 1st year of operation, the vast majority of clinical activity was in the inpatient hospital setting. Growth in the ratio of inpatient consultations per operational hospital beds was noted during the first 5 years of the program, followed by a more modest increase in the succeeding 5 years. In FY 2010, palliative care physicians had 6.2 patient encounters per working day, and APN/PAs, independently evaluated and treated 4.0 additional patients. Conclusion Over the 10 year history, there has been an increase in the number of patient consultations seen by our palliative care program. The clinical burden was manageable during the first 3 years but quickly became too burdensome. Active recruitment of new faculty was required to sustain the increased clinical activity.

Use of Palliative Care Services in a Tertiary Cancer Center

“…Thus, a business model that allows for space and staff expansion will be necessary to accommodate the increase in patient referrals without compromising patient care and adequate number of follow-up visits for previously established patients. We have previously shown that to keep up with increased growth in referral and workload, there needs to be appropriate and timely recruitment of PC clinicians [26]. In FY 2012, we added a second outpatient clinic and increased outpatient palliative clinic physicians from 2 to 3, and again, based on the continued growth, expanded the clinic to 3 locations within the cancer center and increased clinic physicians to 4 per day in FY 2014.…”

“…This PC consultation rate (%) for each FY was calculated as the number of inpatient PC consultations divided by the total number of admissions for the DoCM and Internal Medicine service. Second, we also used our previously reported metric of the ratio of inpatient consultations to the average number of inpatient operational beds per FY [26]. …”

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

“…Several centers have published their experience with freestanding outpatient clinics . In most cases, these clinics have begun as single, one‐half–day clinics per week and have grown quickly with increasing demand . Large cancer centers, such as The University of Texas MD Anderson Cancer Center and the Princess Margaret Cancer Center, have clinics that operate daily and offer both booked and urgent same‐day appointments.…”

Pediatric Palliative Care Programs in Children’s Hospitals: A Cross-Sectional National Survey

“…This finding was not surprising, and it speaks to the rapid uptake of palliative care services by referring clinicians, as has been found in adult palliative care programs. 42 Based on our anecdotal experience providing advice to a wide variety of PPC programs, when programs start, they typically have few staff, yet they are soon inundated with more consultations than can be appropriately managed, leading to allocation of new resources to increase team size. The problem of increasing referrals necessitating more specialist staff has led to a call, in the realm of adult palliative care, for increasing the pipeline of palliative care fellowships and greater generalist palliative care training for all hospital staff so as to offload the demand on specialists.…”