At our Institute, one of the biggest changes we’ve made in the past three years has been strengthening our palliative care team to support our patients. While the team has been adopted nicely into the larger Institute, issues remain regarding timely referrals and even referrals at all from resistant services. Too often an inpatient is referred to the program at the very end of life or after an extended time spent in the ICU. Further downstream, hospice usage and Length of Stay also suffer due to this delayed response. In addition, the capture of Advanced Directives and DNR orders are lacking as well.
Common responses and push back to the utilization of Palliative care is believing that the home service is actually providing the service, or doesn’t want to give up on the patient.
The team is working on a trigger to increase referrals, with MD’s being prompted with the question, “Would you be surprised if the patient were to die within a year?”. In the event that they say “No”, the MD would be forced to state “yes” or “no” as to whether or not the patient is being referred.
I’m curious with the experience on this board. What are the successes that you’ve had in integrating Palliative Care in your systems? Do you have any other way to trigger referrals? Any great successes in improving end of life care (Advanced Directives, Hospice Utilization, etc)?