The sentinel hospitalization and the role of palliative care.
With current healthcare reform and calls for improving care quality and safety, there is renewed emphasis on high-value care. Moreover, given the significant healthcare resource utilization for patients with chronically progressive illnesses or for patients at the end of life, innovative and efficient care delivery models are urgently needed. We propose here the concept of a sentinel hospitalization, defined as a transitional point in the patient's disease course that heralds a need to reassess prognosis, patient understanding, treatment options and intensities, and goals of care. Hospitalists are well positioned to recognize a patient's sentinel hospitalization and use it as an opportunity for active integration of palliative care that provides high-quality and cost-saving care through its patient- and family-oriented approach, its interdisciplinary nature, and its focus on symptom control and care coordination.
Division of Hospital Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
Richard J
RJ
Lin
Ronald D
RD
Adelman
Randi R
RR
Diamond
Arthur T
AT
Evans
D000369:Aged, 80 and over; D002908:Chronic Disease; D003142:Communication; D003363:Cost Control / Q000379:methods; D003657:Decision Making; D003704:Dementia; D018450:Disease Progression; D005260:Female; D006040:Goals; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology; D017051:Hospice Care / Q000191:economics / Q000592:standards*; D020445:Hospitalists / Q000191:economics / Q000592:standards* / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D006278:Medicare / Q000191:economics / Q000592:standards; D009362:Neoplasm Metastasis; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care / Q000191:economics / Q000592:standards* / Q000639:trends; D010190:Pancreatic Neoplasms / Q000473:pathology; D011368:Professional-Family Relations; D011379:Prognosis; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult