Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care.
Source
Medical College of Wisconsin/Froedtert Hospital , Milwaukee, Wisconsin, USA. dweissma@mcu.eduAbstract
Workforce shortages, late referrals, and palliative care program resource constraints present significant barriers to meeting the needs of hospitalized patients facing serious illnesses. The Center to Advance Palliative Care convened a consensus panel to select criteria by which patients at high risk for unmet palliative care needs can be identified in advance for a palliative care screening assessment. The consensus panel developed primary and secondary criteria for two checklists-one to use for screening at the time of admission and one for daily patient rounds. The consensus panel believes that by implementing a checklist approach to screening patients for unmet palliative care needs, combined with educational initiatives and other system-change work, hospital staff engaged in day-to-day patient care can identify a majority of such needs, reserving specialty palliative care services for more complex problems.
Dr. Homburg's commentary :
A recent article about Palliative Care needs in the hospital setting discusses this issue of palliative sedation.
It explains primary palliative care that everyone should be able to do (simple advance care planning, establishing goals of care, discussing DNR status, pain and symptom management, support of caregivers) & specialty level Palliative Care that only those certified should do. Specialty Palliative care Consultation is necessary in my opinion, for the initiation of Palliative Sedation. Specialty privileges should be available to AHS Medical Staff with this certification. Currently Dr Haine and I have passed our certification exam.
The article suggests a consult with a Palliative Care specialist might also be considered for prolonged ICU stays (> 7-10 days?), disagreements about plan of care, pre LVAT, pre AICD, pre feeding tube, pre trach and of course difficult issues with advance care planning, establishing goals of care, discussing DNR status, pain and symptom management, support of caregivers. As the AHS Palliative Care program grows, we'll need to establish better screening to provide appropriate Palliative Care to all the AHS patients in and out of the hospital setting who would benefit from our service.
