Sourcebook : 2.2 Parkland Health Hospital System

Parkland Health & Hospital System in Dallas, Texas, is a 997-bed public hospital serving Dallas County and is affiliated with the University of Texas Southwestern Medical School. Three physicians in Hematology-Oncology, a nurse case manager, a nursing unit manager, a chaplain, and the Vice President for patient services made up the team. They focused on improving care for oncology patients at the end of life, based on observations that appropriate palliative care referrals were occurring only a few days before death—which was, to this team, too late. Here is what they did:

Increase by 50% the number of medical oncology patients receiving palliative services (pain management, social and spiritual support, primary care, and hospice referral) prior to the last month of life.

A change is an improvement if there is a substantial increase in something important, for example:

• Percent of end-of-life patients who receive palliative care services prior to the last month of life
• Mean length of time from palliative care referral until death for these patients
• Percent of palliative care patients who achieve their pain management goals (self-determined)
• Percent of patients and families who are very satisfied with their care

The team felt that all standards should be met, not just increased use of palliative care services. The services had to result in improved experiences for patients.

This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.