Staffing issues and needs - vacations or holidays - can make it hard to assign any given staff person to any given patient. And yet patients and families need to have as small as possible a group of reliable clinicians on whom they can rely virtually around the clock to answer questions, address changes in treatment plans, or respond to crises. In the Detroit Receiving Hospital, for instance, all families with loved ones dying in the ICU can page the palliative care nurse, who then responds immediately to their concerns, fears, or problems. Patients and families know that when they need help, someone they have met and trust will respond.
Hospice has earned a reputation for providing comprehensive care by offering patients access to physicians, nurses, social workers, pastoral care, and community volunteers. The "24/7" (24 hours a day/7 days a week) availability of a good nurse is essential to hospice patients and families. Other health care organizations can emulate this by encouraging an interdisciplinary approach to care of the dying.
Patients and families can also get to know a few key people on the care team. Obstetrical practices offer a model for this approach. Pregnant women routinely meet each obstetrician in a practice, so that they will at least have met the physician who is on call when they go into labor.
7.5.1 Case Study - Hope Hospice
7.5.2 Case Study - Franciscan Healthcare Systems
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].