Like all medical services, palliative care units require standards and procedures. Many organizations use standing orders in their palliative care programs to help ensure that patients receive prompt attention and treatment for a range of problems.
Community Memorial Hospital
Community Memorial Hospital of Menomonee Falls, Wisconsin, is a suburban, nonprofit hospital with 208 beds. In 1997, it had 6,700 discharges, 200 patient deaths from all causes, and 575 newly diagnosed cancer patients.
With the goal of establishing a palliative care program, the improvement team submitted a proposal to its administrative group and its medical staff executive committee. The group aimed to reduce by half the physical symptoms, emotional impact, and resource utilization of dying patients through palliative care initiatives. The group focused on five key dimensions for improvement, setting specific goals within each domain:
Based on its extensive list of standards for patient care, Community Memorial Hospital clearly establishes what patients and providers can expect from the program; these are highlighted in the group's instrument "Standards of Palliative Care."
The programs have been successful. The number of patients seen each month went from about half of terminally ill patients in September to about three-quarters by May. When the program began, 65 percent of patients reported that their pain goals were achieved; eight months later, that figure had increased to 100 percent.
The communication plan set out by the Community Memorial Hospital Palliative Care Program is an excellent outline of how programs can work with other providers and can give patients and families information.
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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 ].