Palliative care in Dutch hospitals: a rapid increase in the number of expert teams, a limited number of referrals.
BACKGROUND
Palliative care expert teams in hospitals have positive effects on the quality of life and satisfaction with care of patients with advanced disease. Involvement of these teams in medical care is also associated with substantial cost savings. In the Netherlands, professional standards state that each hospital should have a palliative care team by 2017. We studied the number of hospitals that have a palliative care team and the characteristics of these teams.


METHODS
In April 2015, questionnaires were mailed to key palliative care professionals in all general, teaching and academic hospitals in the Netherlands. Out of 92 hospitals, 74 responded (80 %).


RESULTS
Seventy-seven percent of all participating hospitals had a palliative care team. Other services, such as outpatient clinics (22 %), palliative care inpatient units (7 %), and palliative day care facilities (4 %) were relatively scarce. The mean number of disciplines that were represented in the teams was 6,5. The most common disciplines were nurses (72 %) and nurse practitioners (54 %), physicians specialized in internal medicine (90 %) or anaesthesiology (75 %), and spiritual caregivers (65 %). In most cases, the physicians did not have labeled hours available for their work as palliative care consultant, whereas nurses and nurse practitioners did. Most teams (77 %) were only available during office hours. Twenty-six percent of the teams could not only be consulted by healthcare professionals but also by patients or relatives. The annual number of consultations for inpatients per year ranged from 2 to 680 (median: 77). On average, teams were consulted for 0.6 % of all patients admitted to the hospitals.


CONCLUSIONS
The number of Dutch hospitals with a palliative care team is rapidly increasing. There are substantial differences between teams regarding the disciplines represented in the teams, the procedures and the number of consultations. The development of quality standards and adequate staffing of the teams could improve the quality and effectiveness of the teams.
Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Room NA22-12, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands. a.brinkman-stoppelenburg@erasmusmc.nl.
A
http://orcid.org/0000-0001-6377-1599
A
Brinkman-Stoppelenburg
Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511DT, Utrecht, The Netherlands.
M
M
Boddaert
Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511DT, Utrecht, The Netherlands.
J
J
Douma
Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Room NA22-12, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
A
A
van der Heide
Hospitals; Observational study; Palliative care; Palliative medicine; Referral and consultation
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