The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up?

Lupu, Dale; Quigley, Leo; Mehfoud, Nicholas; Salsberg, Edward

doi:10.1016/j.jpainsymman.2018.01.011

Cited by 167 publications

(122 citation statements)

References 13 publications

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“…Our total team visits also increased and time to consult was shortened some. Demand for PC services exceeds current resources, 4 and this mismatch is becoming a health-care plight, nationally and internationally. 12 Wisely allocating PC resources is imperative for teams to reach patients with the greatest need.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of a Standardized Triage Process on Efficiency and Productivity of an Inpatient Palliative Care Team

Frendak

Wright

2019

Am J Hosp Palliat Care

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Context: Studies have shown that palliative care involvement delivers a multitude of benefits to patients and caregivers. The existing palliative care workforce is inadequate to meet growing demand. Innovative strategies to triage inpatient consults are necessary. Objectives: To describe the implementation of a new palliative care triage process and to demonstrate its impact on efficiency, teamwork, and patient care. Methods: A quasi-experimental study design, comparing clinical consult data from a 6-month period before and a 6-month period after implementation of the novel consult triage model. Results: Across the 2 study periods, consult demand increased by 44% while the physician staffing (full time equivalent [FTE]) decreased by 38%. Penetration rate per clinical FTE increased (from 1.9%-2.4%; P = .004). Monthly physician work relative value units (RVUs) per FTE increased from 909 to 1678. Physician encounters with hospitalized patients increased from 284 to 353, and total team visits increased from 596 to 891 ( P < .001). Average time to consult decreased by 2.4 hours ( P = .54). Conclusion: An efficient and streamlined consult triage process had a positive impact on our palliative care team’s ability to reach patients. We were able to generate more physician visits and RVUs despite a decrease in physician clinical time, and our penetration rate per physician clinical FTE improved. Our findings highlight the importance of thoughtful and appropriate triage, not to mention teamwork, in helping to augment patient access to palliative care.

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Section: Discussionmentioning

confidence: 99%

“…2 However, the need for PC services exceeds the ability to meet the demand. 4 As such, optimizing allocation of PC resources to patients for whom the greatest benefit will be realized is of the utmost importance. 5 Innovative strategies including efficient and effective triage processes are essential.…”

Section: Introductionmentioning

confidence: 99%

The Effect of a Standardized Triage Process on Efficiency and Productivity of an Inpatient Palliative Care Team

Frendak

Wright

2019

Am J Hosp Palliat Care

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“…Small-scale ACD educational efforts will be exponentially more effective in a system that protects vulnerable populations and produces well-trained palliative care providers. Lupu et al recommend that we reach 30 palliative care specialists per 100,000 elders 76 ; to accomplish this, fellowship incentives and reimbursement policies need to be restructured in a way that prioritizes palliative care. This type of longitudinal change extends beyond the current crisis, but with these solutions in place, we can ensure that providers are well-prepared for the next pandemic with adequate training in palliative care methods and advance directives.…”

Section: Future Directionsmentioning

confidence: 99%

Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions

Gupta

Bahl

Rabadi³

et al. 2020

Am J Hosp Palliat Care

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Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs’ potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.

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“…Currently, the shortage of clinicians with palliative care training continues to increase. 27,28 In the face of this workforce shortage, the American Academy of Hospice and Palliative Care Medicine (AAHPM) has emphasized a delineation within palliative care practice, separating primary (i.e., basic) from specialty (i.e., complex) palliative care, with primary palliative care being carried out by non-palliative clinicians. 29 Meeting the needs of the seriously ill population means developing competency in primary palliative medicine across a broad array of medical specialtiesparticularly specialties such as EM, that have heavy contact with older adults and the seriously ill.…”

Section: The Present -Training and Quality Improvement For Palliativementioning

confidence: 99%

Past, present, and future of palliative care in emergency medicine in the USA

George

Bowman

Aaronson

et al. 2020

Acute Medicine & Surgery

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The emergency department (ED) provides immediate access to medical care for patients and families in times of need. Increasingly, older patients with serious illness seek care in the ED, hoping for relief from symptoms and suffering associated with advanced disease. Until recently, emergency medicine (EM) clinicians have been ill-equipped to meet the needs of patients with serious illness, and palliative services have been largely unavailable in the ED. However, in the past decade, there has been growing recognition from within both the EM and palliative medicine communities on the importance of palliative care provision in the ED. The past 10 years have seen a surge in EM-palliative care training and education, quality improvement projects, and research. As a result, the practice paradigm within EM for the seriously ill has begun to shift to incorporate more palliative care practices. Despite this progress, substantial work has yet to be done in terms of identifying ED patients in need of palliative care, training EM clinicians to provide highquality primary palliative care, creating pathways for ED referral to palliative care and hospice, and researching the outcomes and impact of palliative care provision on patients with serious illness in the ED.

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The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up?

Cited by 167 publications

References 13 publications

The Effect of a Standardized Triage Process on Efficiency and Productivity of an Inpatient Palliative Care Team

The Effect of a Standardized Triage Process on Efficiency and Productivity of an Inpatient Palliative Care Team

Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions

Past, present, and future of palliative care in emergency medicine in the USA

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