Journal of palliative medicine
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Introduction: The emergency department (ED) is a primary entry point of hospitals but does not have a system to identify and consult palliative care (PC) early in patients who meet criteria. Objectives: To determine the measurable effects of an ED PC consultation on patients who meet criteria, hypothesizing that ED PC consultation would lead to decreased average length of stay (ALOS), average direct cost per patient, decreased number of surgeries, and radiological tests performed per patient. Materials and Methods: A physician-led data-driven evidence-based algorithm was designed and piloted with implementation in two hospitals during January-March 2019 in Orlando, FL. ⋯ However, 30-day hospital revisit rates were relatively higher in those who did receive ED PC consultation than those who did not (20% vs. 13% p = 0.15). Conclusions: In this pilot project, PC patients can be identified in the ED with an algorithm that leads to earlier consultation and improved patient outcomes. Larger research trials are needed to replicate this strategy and results.
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Background: Delivery of palliative care in neurointensive care units (neuro-ICUs) can be inconsistent, often due to absence of formal care triggers. The Care and Communication Bundle (CCB) of Quality Indicators provides a standardized process to deliver effective palliative care services in ICUs, but application of these indicators in this setting has not yet been systemically assessed. Objectives: To evaluate the fit of a CCB in the neuro-ICU through a novel scoring system and identify barriers to adherence. ⋯ Identified areas for improvement include documentation of patient and family involvement in care process (i.e., advance directive completion, interdisciplinary team meetings). Conclusions: Application of the CCB in the neuro-ICU is useful for examining adherence to time-based triggers of palliative care standards. The novel scoring system offers opportunities to motivate improvement and reduce variation in palliative care integration.
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Background: Physician Assistants (PAs) are increasingly likely to work in clinical areas where family conference skills are needed, but there is currently a lack of family conference education in PA program curricula. Objectives: To (1) describe a novel interprofessional education (IPE) event for PA students and chaplain residents; (2) examine whether participating in the IPE event is associated with improvements in attitudes and knowledge regarding interprofessional teams; and (3) describe participant perceptions about the event. Design: Two cohorts of PA students and chaplain residents completed a required interprofessional simulation activity involving a critically ill patient and a family conference. ⋯ The largest effect size increases were in PA students' confidence in provider-patient communication at the end of life (Cohen's d > 1.1). Chaplain data demonstrated increases in knowledge of the PA role and likelihood of consulting with PAs in the future. Conclusion: This simulation event improved participant attitudes and knowledge relating to interprofessional interactions in the setting of an end-of-life family conference, and may contribute to more effective collaboration between PAs and chaplains in the clinical setting.
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Background: The five Nordic Associations for palliative medicine (PM) have since 2003 organized a common specialist course for six weeks in two years. Aim: To describe the course: participants, evaluations, impact on participants' careers, and on the development of PM in the Nordic countries. Methods: Information on participants taken from the course archive and national registries. ⋯ Survey response rate 84% (n = 186); 80% of respondents were working in PM, the majority as leaders, >90% engaged in teaching PM. About 40% were active in PM associations, lobbying, and guideline development. Conclusion: The Nordic Specialist Course in PM has had a profound impact on the participants' postcourse careers, influencing the development of PM in the Nordic countries.
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Background: Palliative care (PC) programs worldwide are involved in caring for patients with coronavirus disease 2019 (COVID-19) with other professionals. Objectives: To determine health professionals' perceptions of the contributions of PC in COVID-19 care, and describe its effect on professionals' psychological distress. Design: Cross-sectional study. ⋯ Twenty-five (39%) participants agreed that PC eased distress by communicating with patients, families, and other professionals, providing guidance in difficult conversations and offering companionship. Among respondents, 84% would likely work with PC in the future. Conclusions: During the COVID-19 pandemic, health professionals perceived PC as helpful in caring for patients and families, and in easing their own psychological distress.