Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 8.0 Hospital-Based Palliative Care Consults and Units

The best way to get a good idea is to get a lot of ideas.
- Linus Pauling

Many organizations, eager to do something about end-of-life care, decide that what's needed is a palliative care unit or consult service. There are many advantages to this course, but it does entail risks and difficulties. Before choosing this course, consider the current patient census, existing services that might benefit dying patients and their loved ones, and how a palliative care unit or program would work with other programs, such as hospice and home care.

Palliative care units and services are an excellent approach to care for seriously ill and dying patients - including those who live for years with their illnesses. With their focus on pain and symptom management and psychosocial support, such programs are now underway or have been developed in many communities nationwide. However, not every community can support a program, and every community has different needs or expectations for their services.

In This Chapter

Groups that plan to establish palliative care services or consults must consider many elements, ranging from how to select the patient population to how to bill for services. This chapter describes issues that tend to emerge when organizations begin to consider their need for palliative care services and the goals for such a program; the types of programs that can be established; how programs or consults fit within an institution; and the staff and resources needed to create a palliative care service. Addressing these issues requires managers and clinicians to reflect on their institution's organizational structure and its goals for improving end-of-life care.

Innovators need to know

The ways in which most people die - and will die in the future - will not fit into any particular "box" or program. Services that adapt to patient and family needs, offering support and help for end-of-life concerns even when patients are receiving aggressive treatments, will best meet the needs of many dying patients. Whether groups develop palliative care units or consults, they will improve the end-of-life experience of patients and their loved ones.

  • Organizations can tailor palliative care services to meet patient needs and institutional missions.
  • Palliative care programs offer "teachable moments" for all staff involved in caring for seriously ill patients.
  • Palliative care programs expand hospice-like service to an array of patients with diseases that will prove fatal over the course of many months or several years.
  • Careful analysis of existing services and programs, and of ways to integrate these with a palliative care program, is essential.
  • Programs can be led by different practitioners, from physicians with expertise in palliative care to certified nurse specialists with similar expertise.

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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 ].

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