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Patients who are referred to the Palliative Care Division are managed
in a model of care designed to ensure that patient needs are matched to the appropriate
services throughout the course of the disease (view
the model). Inpatients at the Petrie Division of Beth Israel Medical Center
are referred to the Department's consultation team. Outpatients are referred to
a physician in the Department's ambulatory practice. Continuum
Hospice Care, which is administered by the Palliative Care Division, can also
receive direct referrals of patients who meet criteria for a hospice program referral.
Inpatients or outpatients who are referred to the Department's physicians include
patients who are referred specifically to facilitate a transfer to the hospice program,
and those patients who are not appropriate for hospice and are referred for a variety of
reasons (e.g., poorly controlled symptoms, the need for a comprehensive palliative care
approach, or specific issues related to the imminently dying).
The non-hospice palliative care patients, whether inpatient or outpatient, can
be broadly divided into two categories. Some patients have limited needs and can
be managed in a traditional physician-based approach. Ambulatory patients of this
type are usually followed through periodic office visits.
Non-hospice palliative care patients with more extensive needs are managed in
a nurse/social worker-directed case management approach. The initial evaluation
for these patients often involves the physician, nurse, social worker, and possibly
other members of the palliative care team.
All patient cases are discussed at a weekly meeting where decisions are made about
the best type of care that might be offered the patient. Patients who are already
in the practice and are having active problems also are discussed. The services
offered to the patient can be changed as needed to optimize care within the resources
available to the Department and to the patient and family.
Patients who are followed for a period of time may become candidates for referral
to the hospice program. Hospice is viewed as a wonderful resource for providing
comprehensive services for patients with advanced illness who are no longer receiving
aggressive disease-oriented therapies. Patients may be referred to the hospice
program by the physician, by the nurse or social worker in consultation with the
physician, or by appropriate individuals in the home care nursing agency or long-term
care facility.
Patients who elect admission to the hospice program are provided a range of services.
The program has a weekly interdisciplinary team meeting, at which patients are
discussed and the care plan changed as necessary. The hospice program provides
access to nurses, psychosocial support, chaplaincy services, volunteers, and other
services.
Occasionally, patients who have elected the hospice program must withdraw from
it. In contrast to the situation in other settings, patients in our model can
return to the case management approach and have continuity of care provided by
the physician and others in the team.
The Department of Pain Medicine and Palliative Care maintains an 18-bed inpatient
pain and palliative care unit. Hospice patients who meet criteria for an inpatient
stay, non-hospice palliative care patients with acute medical problems, and highly
selected patients with chronic pain may all be admitted to the unit under the
direction of an attending physician in the Department. Non-hospice palliative
care patients who are admitted may use this event to change the type of care provided
after discharge by electing hospice, if appropriate, during the admission.
The family, broadly defined, is considered the unit of care in palliative care.
Caregivers may be offered support in a variety of ways while the patient is being
treated either within the hospice program or within the broader model of palliative
care. If a patient who has elected hospice dies, the caregivers will be provided
access to a bereavement program. Over time, bereavement services will be expanded
to the caregivers of non-hospice palliative care patients as well.
American Academy of Hospice and
Palliative Medicine
American Board of Hospice and
Palliative Medicine
Continuum Hospice
Care
End-of-Life Physician Education
Resource Center
European Association for Palliative
Care
Growth House, Inc.
Hospice Cares
International Hospice Institute
& College
National
Hospice and Palliative Care Organization
U.S. Dept. of
Health and Human Services: A Clinical Guide on Supportive and Palliative Care
for People with HIV/AIDS, 2003
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