Inpatient Palliative Care

Our Vision… Our Vision - to provide quality care to patients who suffer from a serious medical condition. Palliative Care teams improve quality of care and support both the primary physician and patient by providing: Time to devote to intensive family meetings and patient/family counseling Expertise in managing complex physical and emotional symptoms such as pain, shortness of breath, depression and nausea Support and communication for resolving patient/family/physician questions concerning goals of care Coordination of care transitions across healthcare settings.

Our Model… Collaborative MD (Consultative) Nurse Practitioner (1.0 FTE) Medical Social Worker (1.0 FTE) Chaplain Services (Consultative)

Our Role… Role: Palliative Care Consultation Team Symptom Management Advance Care Planning Psychosocial/spiritual support Communication and support for patient/family Provide guidance regarding medical decisions and technologies Guidance for transitions/care options

Wait…isn’t palliative care really hospice? Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of palliative care doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. Center to Advance Palliative Care 2011

Consult Triggers Palliative Care Screening Tool To qualify for palliative care, patients must have a serious, life-threatening illness** and one or more of the following:  Not Surprised - You would not be surprised if the patient died in the next 12 months  Bounce-Backs - More than one ED visit or hospital admission for the same condition within several months  Uncontrolled Symptoms - ED visit prompted by difficult-to-control physical or psychological symptoms  Functional Decline - Decline in function, feeding intolerance, unintentional weight loss or caregiver distress  Increasingly Complicated - Complex long-term care needs requiring more support Source: 2011 IPAL-EM Project, Center to Advance Palliative Care. Palliative Care ED Screening Tool.

Serious, Life Threatening Illness **Examples of patients with a serious illness that frequently benefit from a palliative approach include:  Difficult symptom control in chronic diseases like: COPD, CHF, CRF, etc.  Transfers from LTCF or other medical home  Metastatic or locally advanced incurable cancer – even if seeking chemo/radiation.  Hospice program enrollees or newly identified hospice eligible patients  Out-of-hospital cardiac arrest  Advanced dementia (defined as needing assistance with ADL’s; limited to no coherent speech, limited to no ambulation, and incontinent) Source: 2011 IPAL-EM Project, Center to Advance Palliative Care. Palliative Care ED Screening Tool.

But…I can’t refer them to palliative care… ”She’s not ready yet” ”She will lose hope” “There is nothing more we can do”

What Do Patients with Serious Illness Want? Control of pain and symptoms Avoid inappropriate prolongation of the dying process Achieve a sense of control Relieve burdens on family Strengthen relationships with loved ones Source: Singer et al, JAMA 199: 281(2):

What Do Family Caregivers Want? Honest information To be listened to Privacy To be remembered and receive communication and information Source: Tolle et al. Oregon report card

Hospital Care of the Dying 50% of US Deaths Family Satisfaction Not enough contact with MD: 78% Not enough emotional support Not enough information about what to expect with the dying process Not enough help with pain/dyspnea Source: Teno et al. JAMA 2004; 291:88-93

When To Consider Palliative Care Do you have any difficult pain or symptom problems? Do you have unrealistic/stressed patients or families? Do you have patients who keep getting readmitted? Would you be surprised if your patient died in the next year?

Transitions – Discharge Planners PC can help with the outpatient discharge plan by providing education regarding outpatient disposition. SOMC Outpatient Services Include: Palliative Care: House Calls (72 hour follow up after discharge by NP) SOMC Home Health: Palliative Care Hospice SNF ALF

Our Benefit To You… Save time by helping to handle repeated, intensive patient-family communications, coordinating care across settings, comprehensive discharge planning. Bedside management of pain and distress of highly symptomatic and complex cases, thus supporting the treatment plan of the primary physician Promote patient and family satisfaction with the clinician’s quality of care.

Why Here? Why Now? SOMC 2015: 234 Imminent Death (to Inpatient Hospice) Consults at SOMC in % (434/775) Hospice referrals were from SOMC Main Campus or ED 204 Hospice referrals were rejected (potiential PC targets) 22 patient were admitted to hospice at the Main Campus #1 Hospice referral source in 2015: Hospitalists (312) 40%

Our Team… Chad Lore, MS, NP-C Nurse Practitioner Ryan Lawson, MSW, LSW Medical Social Worker Teresa Ruby, MBA Director Hospice & PC Teresa Bryan, MSW, LISW-S Director Social Services Scott Hilbert Liaison, Hospice & PC Dr. Una Ijeoma-Nchinda PC Collaborative MD

Consults Consults must be entered into CPOE as an order. Consultations can be communicated with the IPPC Team at X2621. IPPC Consultations will be available Monday-Friday 8AM-430PM. Other hours by arrangement.

Any Questions? Safety  Quality  Service  Relationships  Performance