The clinical, operational, and financial worlds of neonatal palliative care: A focused ethnography

AbstractObjective:Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center.Method:In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families.Results:Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support.Significance of results:The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

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Commentary: Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

Palliative & Supportive Care ◽

10.1017/s1478951504040568 ◽

2004 ◽

Vol 2 (4) ◽

pp. 419-423 ◽

Cited By ~ 5

Author(s):

STEVEN D. PASSIK ◽

CAROL RUGGLES ◽

GRETCHEN BROWN ◽

JANET SNAPP ◽

SUSAN SWINFORD ◽

...

Keyword(s):

Palliative Care ◽

Medical Center ◽

Academic Medical Center ◽

Cost Savings ◽

Care Program ◽

Palliative Care Program ◽

Potential Cost ◽

Physician Visits ◽

Financial Benefits ◽

Simple Models

The value of integrating palliative with curative modes of care earlier in the course of disease for people with life threatening illnesses is well recognized. Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration of modes of care can be achieved, financed and sustained is an ongoing challenge for the health care system in general as well as for specific institutions. When the initiative comes from a hospital or academic medical center, which may, for example, begin a palliative care consultation service, financial benefits have been well documented. These palliative care services survive mainly by tracking cost savings that can be realized in a number of ways around a medical center. We tried to pilot 3 simple models of potential cost savings afforded to hospice by initiating a palliative care program. We found that simple models cannot capture this benefit (if it in fact exists). By adding palliative care, hospice, while no doubt improving and streamlining care, is also taking on more complex patients (higher drug costs, shorter length of stay, more outpatient, emergency room and physician visits). Indeed, the hospice was absorbing the losses associated with having the palliative care program. We suggest that an avenue for future exploration is whether partnering between hospitals and hospice programs can defray some of the costs incurred by the palliative care program (that might otherwise be passed on to hospice) in anticipation of cost savings. We end with a series of questions: Are there financial benefits? Can they be modeled and quantified? Is this a dilemma for hospice programs wanting to improve the quality of care but who are not able on their own to finance it?

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Fostering patients and families during end-of-life care.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.150 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 150-150

Author(s):

Michelle Tufaro ◽

Jim Devries

Keyword(s):

Palliative Care ◽

End Of Life ◽

Medical Center ◽

Care Program ◽

Care Plan ◽

Additional Patient ◽

Palliative Care Program ◽

Spiritual Assessment ◽

Care Plans ◽

Interdisciplinary Process

150 Background: Hunterdon Palliative Care Program is a service owned and run by Hunterdon Medical Center, a non-profit, Magnet-recognized, community hospital of 178 beds for the residents of Hunterdon County in New Jersey. The program strives to provide the highest quality patient and family-centered care for seriously ill and terminal patients. Our goals include respect for patient autonomy, values and personal decisions, as well as minimizing of symptom distress, optimizing supportive interventions and services for patients and their families. The individual need of each patient is determined by an interdisciplinary process that includes the ongoing clarification of goals of care. In order to achieve this we have developed several tools to capture the unique needs of each patient and encourage a daily interdisciplinary process. Methods: Three tools were developed to incorporate and utilize the expertise of each individual team member which includes physicians, nurse practitioner, social worker, chaplain and a reiki master. Results: The tools are currently being used by all in-patient palliative care patients. The psych-social-spiritual assessment and care plan sheets are completed within 24 hours of the initial consultation. The documents are placed on the chart next to the written consult. Daily rounding sheets are placed in the progress notes section of the chart. All members of the patient’s treatment team are encouraged to utilize the forms. Both the care plan note and the daily rounding sheet include a section for input from other disciplines. A hot pink strip is located at the bottom of each sheet to make it easy for others to identify forms for integration into additional patient care plans. Conclusions: The Palliative Care Program was awarded Certification by The Joint Commission, with no recommendations for improvement! The interdisciplinary approach to a patient’s end of life needs was sited as "superior" for clinical documentation with special attention to the psycho-social spiritual assessment as a “best practice” standard.

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Interdisciplinary Palliative Care Teams

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0007 ◽

2019 ◽

pp. 89-97

Author(s):

Polly Mazanec ◽

Rebekah Reimer ◽

Jessica Bullington ◽

Patrick J. Coyne ◽

Herman Harris ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Medical Center ◽

Academic Medical Center ◽

Interdisciplinary Team ◽

Palliative Care Team ◽

Care Team ◽

Patient Centered ◽

Team Members ◽

Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

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