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The Palliative Care Team at Regions Hospital
To cure sometimes, to relieve often, to comfort always.
— Fifteenth century French folk saying
Thank you for your interest in the Hospice & Palliative Care Team at Regions Hospital. Following is some information about how and why we created a hospital-based palliative care team. If you are a health care provider or administrator who would like to learn more about our team, call 651-254-1773.
Defining palliative care
Palliative care aims to relieve suffering and improve quality of life for both patients with advanced illnesses and their families.
Our palliative care team includes medical and nursing specialists, social workers and clergy. The team delivers the highest quality of care to patients with advanced illnesses. Pain and symptom control is integrated into all stages of treatment.
The palliative care approach has been shown to decrease length of hospital and intensive care unit stays and eases patient transitions between care settings, resulting in increased patient and family satisfaction.
Why have palliative care programs in hospitals?
According to a well-known study, when asked, 90 percent of people would prefer to die in their own home in the company of their loved ones. In the United States, however, 53 percent of patients die in hospitals and 24 percent die in nursing homes. Many patients need palliative care to complement their life-prolonging or curative treatments in the hospital. Seriously-ill hospital patients are highly likely to need pain and symptom control, coordination among their providers and assistance in transitioning between care settings.
Hospitals are where the most money is being spent. Nearly all Medicare beneficiaries spend at least some time in a hospital during their last year of life. Medicare hospital payments rose 9.2 percent in 2001 and 10 percent in 2002. Enormous resources are expended on the seriously ill, putting the hospitals that treat them at financial risk if they cannot find a way to provide care that is both high quality and fiscally responsible.
Hospitals are the best place to plan for the next phase in the care continuum. Most patients are in the hospital due to a health crisis. This crisis forces confrontation with the reality of illness and the decisions that need to be made about care. The hallmarks of palliative care — communication and coordination, combined with excellent medical care — ensure that hospitalized patients have smooth transitions between the hospital and appropriate outpatient services such as hospice, home care, transitional care or nursing homes.
The care patients want
Health consumers are demanding high standards of care and an active role in their treatment. Increasingly, hospitals are expected to deliver this level of care in the areas of pain and symptom management. In its annual ranking of hospitals, U.S. News & World Report now includes the presence of palliative care services in its evaluation criteria.
Numerous studies of people with serious illness show they want the types of services that palliative care provides:
Improving clinical outcomes
Outcomes of palliative care:
- Palliative care relieves pain and distressing symptoms. Palliative care programs significantly reduce pain levels and increase patient satisfaction with pain management. Numerous studies also show palliative care controls fatigue, anxiety, breathlessness, nausea, depression, constipation and other sources of symptom distress.
- Palliative care helps with difficult decision-making. Palliative care teams meet with patients and their families to discuss goals of care and develop treatment plans. This intensive communication results in a high level of patient and family satisfaction and smooth coordination of care between settings.
- Palliative care helps patients complete life-prolonging or curative treatments. Pain and other symptoms result in complications and slower recovery for patients. Studies show that cancer patients receiving palliative care during their chemotherapy are more likely to complete their cycle of treatment, stay in clinical trials and report a higher quality of life than similar patients who did not receive palliative care.
- Palliative care increases the ease of referral to other appropriate care settings. Palliative care programs transition patients from the hospital to the most appropriate services or care settings. For example, studies show palliative care programs can double or triple hospice referral rates for patients in the last weeks of life. In addition, palliative care programs facilitate communication about the most appropriate care setting to achieve the goals of care, resulting in reduced hospital and ICU lengths of stay.
Meeting the needs of an aging population
Hospitals are filling rapidly with seriously ill and frail adults. By 2030, the number of people in the U.S. over the age of 85 is expected to double, to 8.5 million. Palliative care is essential to achieving the goal of excellent and cost-effective care for the growing population of people living with advanced illness. Thanks to modern medicine, people are living longer with chronic and advanced illness. Palliative care provides continuity of care and a level of coordination that responds to the episodic and long-term nature of these illnesses. These seriously ill patients:
- Deal with multiple chronic illnesses with which they will live for years, including heart and lung disease, diabetes, cancer and Alzheimer’s disease
- Face a complex medical system and struggle to coordinate their care among the host of doctors and specialists who treat them
Easing of burdens on staff, increased retention
Given the complexities and fragmentation of today’s health care system and the growing medical needs of the chronically ill, provision of well-communicated and highly coordinated care requires tremendous staff time and effort. Palliative care programs have been shown to help hospital staff provide this level of coordinated care for their patients, thus increasing staff job satisfaction and retention. Palliative care programs assist staff by:
- Providing patient-family case management and coordination
- Ensuring safe and effective management of complex and changing symptoms
- Supporting and assisting physicians, nurses and social workers in their efforts to provide the highest quality bedside care to patients and their families
Meeting JCAHO accreditation standards
The cornerstone of palliative care is to ensure that patients do not suffer from uncontrolled symptoms. Accredited hospitals are committed to meeting national standards for effective pain treatment. Palliative care programs help hospitals meet pain and other quality standards developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Increased patient & family satisfaction
Providing patient-centered care increases patient and family satisfaction with hospital services and builds loyalty to the institution.
Flexible programs support the primary care physician
Leading hospitals recognize the challenge of caring for the seriously ill in the busy hospital setting. Palliative care programs help address these issues by focusing on supporting the primary physician and nurse responsible for the care of these patients.
Palliative care teams provide primary physicians with:
- Time by helping with care coordination and time-intensive patient-family communication about the goals of care
- Expertise in pain and symptom management, particularly for complicated cases where relief of symptoms is difficult to achieve
- Support for the plan of care by helping coordinate the treating physician’s orders, including safe and effective discharge planning
- Satisfied patients who receive palliative care as part of their overall medical treatment have a high level of satisfaction with their physicians, health care team and hospital
Lower costs for hospitals & payers
Developing palliative care programs in hospitals requires a relatively low start-up investment and can have an immediate impact on outlier cases, overall resource use and ICU utilization. Direct program costs are more than offset by the financial benefit to the hospital system.
Hospitals with palliative care programs find that:
- Patients are transitioned to appropriate levels of care. This transition often reduces length of stay, especially in the ICU.
- Proactive care plans expedite treatment. Hospitals can better plan daily resource use by following the agreed-upon care approach, often reducing costs for redundant, unnecessary or ineffective tests, procedures and pharmaceuticals.
- They maintain high quality of care while increasing capacity and reducing costs through shorter lengths of stay and lower ancillary and pharmacy costs.