Palliative care in U.S. hospitals is growing, with 1,568 operational programs in nearly 2,500 hospitals, according to the most recent tally from the American Hospital Association and the Center to Advance Palliative Care. And as palliative care becomes a staple of inpatient care, hospitalists across the country become more involved in end-of-life care planning.
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At Kaiser Permanente’s San Rafael Medical Center in California, most of the 21-member hospitalist group has been learning palliative-care concepts through grand rounds, practice updates, and self-study. Hospitalists are incorporating the concepts into routine practice and doing palliative-care consults and family meetings, says Robert Lavaysse, MD, who started the inpatient palliative-care team at San Rafael. About 10 hospitalists will join nephrologists, oncologists, and pulmonologists and sit for board certification in hospice and palliative medicine (HPM), a subspecialty recognized by 10 medical boards of the American Board of Medical Specialties. The Oct. 4 board exam is the last time physicians can earn the recognition without first completing a full-year HPM fellowship.
At Monarch Healthcare, a large physician group in Southern California, a dozen employed hospitalists and “SNFists” have been working with the palliative-care team at the University of California Irvine (UCI) Medical Center, says Vincent Nguyen, DO, CMD, Monarch’s medical director for geriatrics and palliative care. The hospitalists, who work seven-on, seven-off schedules, are using “off” weeks to train at UCI. Nine have completed six weeks of training and plan to sit for the HPM boards in October. Dr. Nguyen also pulled in palliative-care experts for 26 hours of didactic presentations, and invited hospices from the community to hold their interdisciplinary team meetings at the medical group’s office so that interested hospitalists could sit in and observe how hospice cases are managed.
—Edward Merrens, MD, FHM, hospital medicine section chief, Dartmouth-Hitchcock Medical Center, Hanover, N.H.
“Every physician who has gone through this experience is utilizing it in daily practice and influencing their colleagues,” Dr. Nguyen says. He also says hospitalists need to learn to “slow down a bit” with seriously ill patients, many of whom are good candidates for palliative care. He suggests hospitalists make certain that patient goals of care are elicited and advance directives are captured, and that they are 100% ready for the next care transition.