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Palliative Care Gets a Checklist
|By Haydn Bush
H&HN Senior Online Editor
|January 23, 2013|
A hospital association builds a palliative care checklist.
One of the quirks of writing for a monthly publication is that we rarely follow up directly on the hospitals and executives we profile. Back when I was a newspaper reporter, we'd cover stories repeatedly until they ran their course, but our national, trend-oriented focus here at H&HN means we don't often have the time or space to go back and follow up. In other words, we rarely know how the story turns out after the opening act.
So I was intrigued recently when I heard from the Greater New York Hospital Association, which I cited extensively last year for a piece on the growth of palliative care programs in hospital emergency departments. After an initial inquiry, I ended up chatting with GNYHA Project Manager Sara Kaplan-Levenson, who helps manage the association's Palliative Care Leadership Network.
The last time I spoke with Kaplan-Levenson, the network was just getting started — since that time, 30 hospitals have signed on to participate in the collaborative. And while Kaplan-Levenson told me during our initial conversation that the GNYHA was steering away from advising hospitals on prescriptive approaches to palliative care, the advisory group representing the hospitals brought together enough clinical know-how to build a comprehensive palliative care bundle.
The bundle includes three pieces — a trigger tool for identifying patients, the development of a patient plan and a post-discharge framework for planning patient care and family caregiver responsibilities. The patient plan is the centerpiece of the bundle; steps include the assessment of symptoms, a "goals of care" conversation with patients and families, an interdisciplinary assessment and the formal documentation of all elements of care.
Despite the checklist approach, the providers range quite a bit in both size and the scope of their existing palliative care programs. The hospitals also have a variety of methods for identifying patients, from triggers in electronic medical records to identification by emergency department or critical care clinicians.
Each hospital also takes a different approach to building an interdisciplinary team, Kaplan-Levenson told me. Hospitals with more longstanding palliative care initiatives can often put together a team of palliative care specialists relatively easily, while facilities with shorter track records have to work to gain buy-in from a larger group of clinicians. But that brings its own advantages — Kaplan-Levenson says that hospitals without dedicated palliative care teams are often able to build a more robust base of clinicians, and can avoid being siloed.
"It's allowed them to reach out to other folks beyond the team," Kaplan-Levenson says.
So what's next for the initiative? Kaplan-Levenson is still waiting to receive data submissions from the hospitals on the effectiveness of the bundle; from there, the GNYHA will figure out where to go next. For now, she says she's hopeful that the discussions between the diverse providers have helped both longtime palliative care advocates and newer players.
"There is a nice diversity within the collaborative and the colleagues sitting around table," Kaplan-Levenson says. " The learning goes both ways."
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.