title: You need not make the journey alone: overcoming impediments to providing palliative care in a public urban teaching hospital.
abstract: The majority of dying patients continue to receive care in acute, tertiary settings. This has generated the development of hospital-based palliative care (HBPC). The Symptom Management and Palliative Care Program (SMPCP) at LAC+USC Medical Center provides HBPC. The SMPCP operates as an interdisciplinary consultative service, assessing inpatients, and documenting recommendations for primary physicians. Over a 28-month period the SMPCP provided clinical recommendations, education, and research for patients, family members, and hospital staff Demographic, clinical, psychosocial, financial, and outcome information was collected on 265 patients. The SMPCP documented the attainment of defined quality end-points, including pain control within 24 hours, a Do Not Resuscitate (DNR) discussion with patient and family within 72 hours, and control of nausea and vomiting within 24 hours. Team members also documented impediments to implementing recommendations and the success of interventions to overcome impediments. Results indicated that the SMPCP achieved a high rate of quality end-point attainment when impediments were not present. The most significant impediments resulted from behaviors by primary physicians. The SMPCP's ability to overcome barrier behaviors improved the rate of end-point attainment, confirming the importance of palliative care at the end of life.
authors.affiliation: LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, USA.
authors.forename: Angèle
authors.initials: A
authors.lastname: Ryan
authors.forename: Jackie
authors.initials: J
authors.lastname: Carter
authors.forename: Janet
authors.initials: J
authors.lastname: Lucas
authors.forename: Jack
authors.initials: J
authors.lastname: Berger
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D017051:Hospice Care / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration*