More than 90% of people in the US die in an institution, primarily in an acute care hospital, most often secondary to complications of a chronic illness. Many die suffering various aspects of “total pain” with its physical, emotional, social and spiritual components. Their caregivers are often equally burdened.
As part of a statewide initiative involving 40 hospitals, Hoag Memorial Hospital, a 400-bed not-for-profit acute care community hospital, developed and implemented a palliative medicine consult service (PMCS) from existing hospital and medical staff resources. Building on a clinical pathway of comfort care for dying patients (supportive care pathway [SCP]) in existence since 2000, an interdisciplinary team of physicians, social worker, nurses and chaplain received training in palliative care, developed a team approach to the care of the patient and initiated the service
542 in-patients died in this community hospital in CY 2002; 76 died while on the SCP; another 20 were discharged to hospice and other care. This report reflects the experience of expanding the impact of this pathway by implementing a PMCS to address the needs of seriously-ill and/or dying patients admitted to the hospital. The steps taken in the development of this service, including identifying potential obstacles and how they were addressed will be presented. The experience of the first eight months of the operation of the PMCS will also be presented. Issues of team interaction, leadership support, staff in-service and marketing of the service will be discussed as a potential template for other hospitals.CONCLUSIONS: A PMCS can be developed and implemented in an acute care community hospital utilizing local resources.CLINCAL IMPLICATIONS: The suffering of inpatients with complex and life-threatening illnesses can be treated in a comprehensive manner utilizing an interdisciplinary team approach to palliative care.
P.A. Selecky, None.