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During its year-long project for the Breakthrough Series, the team from the Good Samaritan Regional Medical Center in Phoenix, Arizona, established a palliative medicine program. A nurse practitioner who reports to the medical director leads the program, which operates as a separate unit within the hospital. The multidisciplinary team includes social services and pastoral care.
Good Samaritan uses several methods to track performance, such as referral sources, patient disposition, and money saved or costs avoided. The following tables chart the data Good Samaritan collected on these variables.
| Table 8.1 Referral Sources to Palliative Medicine Program | ||||||
|---|---|---|---|---|---|---|
| Discharge | ||||||
| Referral Sources | Total | Died | SNF* | Home | Hospital | Hospice |
| Academic medical service | 13 | 1 | 5 | 3 | 4 | 1 |
| Palliative medicine director from geriatrics practice | 65 | 6 | 36 | 22 | 1 | 10 |
| Other geriatric practice | 2 | 1 | 2 | -- | -- | 1 |
| Misc. hospital referral | 4 | 1 | 1 | 2 | -- | 1 |
| Consults only | 16 | 4 | 2 | 2 | 8 | 1 |
| Total | 100 | 13 | 46 | 29 | 13 | 14 |
| *SNF - skilled nursing facility | ||||||
| Reprinted with permission of Good Samaritan Regional Medical Center, Phoenix, AZ | ||||||
| Table 8.2 Financial Effect of Palliative Medicine Service | ||||||
|---|---|---|---|---|---|---|
| Patient | Age | Diagnosis | Hospital LOS* | Palliative LOS | Cost | Cost Avoid+ |
| A | 91 | CHF, renal failure, pneumonia | 3 | 11 | $4,060 | $1,000 |
| B | 86 | Dementia, atrial fibrillation | 0 | 2 | $850 | $1,000 |
| C | 77 | Intracerebral bleed | 10 | 7 | $11,574 | $15,000 |
| D | 87 | Dementia, hip fracture, pneumonia | 0 | 3 | $1,487 | $3,000 |
| E | 93 | Dementia | 0 | 1 | $649 | $1,000 |
| Total | $18,620 | $21,000 | ||||
| *LOS--length of stay +Cost avoid--estimates based on ICU days avoided by consultation or transfer to Palliative Medicine Service | ||||||
| Reprinted with permission of Good Samaritan Palliative Care Unit, Phoenix, AZ | ||||||
The team from Good Samaritan also surveyed families for satisfaction with the health care service, both before and after the palliative care service was established. Before it was created, only 30 percent of families said that doctors or nurses had talked to them or to the patient in ways they could understand about end-of-life issues. Little more than nine months later, 100 percent of those surveyed said such conversations had occurred.
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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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