The creation of a certified palliative care program in a community hospital through education

Lynne Kennedy, Karlynn BrintzenhofeSzoc

Abstract

Background: A community hospital implemented a Palliative Care Team (PCT) and achieved Advanced Palliative certification by The Joint Commission (TJC), the 29th in the country and the first for a community hospital. The overarching goal was to improve the quality of life for both patients and their families treated at the hospital. The specific aims of implementing the PCT included changing the culture of the hospital through education, delivered formally and informally, at every level of hospital clinical and medical staffing and to increase acceptance of palliative care. The formal education provided information on how the PCT could improve the quality of patient care, support providers and staff in their practices, improve the satisfaction of the patient and family members with hospital services, improve the quality of life, and outlining palliative and hospice care and their differences. Those trained were medical providers, nurses, social workers, physiotherapists, dieticians, and occupational therapists. For informal education four nurses from strategic areas in the hospital were educated as End-of-Life Nursing Consortium (ELNEC) Trainers in order to educate their colleagues and offer support. Champions were utilized who provided peer-to-peer consultation on how the PCT helped their patients.
Methods: Retrospective data from the first 3 years of certification were extracted from the electronic health record (EHR) resulting in a sample of 1,408. The data were compared across the 3 years to evaluate the effectiveness of the newly launched PCT.
Results: The first 2 years had a similar number of patients with over a 37% increase year 3. A decrease in length of stay (LOS) between admission and referral, the increase in patients being seen with a level of care of 4, along with annually reduced age, suggests that patients were being referred closer to diagnosis. The decrease in discharges to hospice and an increase of discharges home indicated earlier disease trajectory consults.
Conclusions: The escalation of patient referrals was interpreted to demonstrate acceptance approval of the program. The decrease in LOS and readmission patterns illustrated the success of the team approach. This transformation in patient care was linked to the standardized education for all medical and clinical staff using evidence-based guidelines to develop and streamline processes. The findings support that the culture of the community hospital changed over the 3-year period and PCT has become a part of the fabric of patient care.