Optimizing the Success of a Palliative Care Consult Service: How to Average Over 110 Consults Per Month

Abstract

The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. The PCCS is a mobile interdisciplinary team established to provide accessible, comprehensive end-of-life care and symptom management to patients with advanced illness within the health care system. Critical to its success, the team developed and maintained a database to document growth and ensure continuous quality improvement. A description of this database is provided, along with current performance outcomes. The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.

Functions and Outcomes of a Clinical Medical Ethics Committee: A Review of 100 Consults

“…This too would clearly be an area that should be considered for further investigation. While feedback from participants in each EC consult and feedback from clinicians who requested PCCS consults (Radwany et al 2009) has been consistently positive; we have not obtained feedback systematically from individuals participating in both, nor has follow up feedback 6 or 12 months post-EC consultation been obtained. In addition, we have presumed that stable EC membership with low turnover improves the quality of consultations, though no such proof exists.…”

“…Given the mission and work of the PCCS, some of the cases regarding withdrawal of life sustaining treatment may have shifted from the EC to the PCCS and contributed to this decline. More remarkable is the volume of such cases identified through the PCCS database growing to several hundred per year by the time the service had matured (Radwany et al 2009). …”

Clinician Roles in Early Integrated Palliative Care for Patients with Advanced Cancer: A Qualitative Study

“…The evolution of clinician work through the patients' disease trajectory is a key feature of early palliative care in the outpatient setting that differs from inpatient palliative care consultation, which typically focuses on acute symptom control and the care of imminently dying patients. [6][7][8][9][10] For example, in a study of an inpatient palliative care service, the most common symptom for consultation was delirium. 11 These differences suggest that palliative care clinicians caring for patients with advanced cancer earlier in the course of their illness may require specific training.…”

Overcoming Barriers to Palliative Care Consultation

“…The use of triggers, preferably refined as a checklist developed specifically for each critical care unit, provides an objective basis for determining the time to begin a conversation about palliative care. [17][18][19] Waiting until a reluctant health care provider is ready to request consultation is no longer necessary. Using a list of standardized criteria or triggers for palliative care consultation can increase consultation rates from 41% to 82% and reduce 30 day rehospitalizations from 36% to 17%.…”

“…Examples include attendance of a palliative care nurse practitioner at daily multidisciplinary rounds to address the appropriateness of patients for palliative care consultation, 23 daily prerounding with nurses to identify patients at risk for poor outcomes who might benefit from a consultation, 17 and requiring consultation when specific hospital-identified criteria for palliative care consultation are met. 18 A common thread identified in strategies that led to successful integration of palliative care into critical care was the presence of nurse or nurse practitioner champions. These nurses were generally well known and respected in the specific critical care environment and were compelling advocates for palliative care consultations.…”