CONTEXT: Studies have shown that palliative care involvement delivers a multitude of benefits to patients and caregivers. The existing palliative care workforce is inadequate to meet growing demand. Innovative strategies to triage inpatient consults are necessary.
OBJECTIVES: To describe the implementation of a new palliative care triage process and to demonstrate its impact on efficiency, teamwork, and patient care.
METHODS: A quasi-experimental study design, comparing clinical consult data from a 6-month period before and a 6-month period after implementation of the novel consult triage model.
RESULTS: Across the 2 study periods, consult demand increased by 44% while the physician staffing (full time equivalent [FTE]) decreased by 38%. Penetration rate per clinical FTE increased (from 1.9%-2.4%; P = .004). Monthly physician work relative value units (RVUs) per FTE increased from 909 to 1678. Physician encounters with hospitalized patients increased from 284 to 353, and total team visits increased from 596 to 891 (P < .001). Average time to consult decreased by 2.4 hours (P = .54).
CONCLUSION: An efficient and streamlined consult triage process had a positive impact on our palliative care team's ability to reach patients. We were able to generate more physician visits and RVUs despite a decrease in physician clinical time, and our penetration rate per physician clinical FTE improved. Our findings highlight the importance of thoughtful and appropriate triage, not to mention teamwork, in helping to augment patient access to palliative care.
Research aims: This scoping review maps the existing literature on narrative interventions within a palliative care and end-of-life context.
Methods: A scoping review was performed to address the research question: What observational or randomized controlled trials have been performed to evaluate narrative interventions in the palliative care setting? A search across multiple electronic databases was performed. The search results were screened. Relevant articles were reviewed for the identification of common themes and challenges.
Results: After reviewing 495 citations from electronic searches, and 44 articles from author archives or from manual review of article reference lists, we identified 34 articles for inclusion. Narrative interventions have focused on reflection or communication, and have been studied among providers, students, patients, and caregivers. Only patient/caregiver studies utilized randomized controlled design. Most studies were small and at the level of evaluating feasibility. Challenges include a high degree of heterogeneity among interventions, as well as heterogeneity among parameters for evaluating those interventions.
Conclusion: Narrative interventions are actively being evaluated with the intention of improving communication and wellbeing among all parties within the palliative care and end-of-life experience. The field would benefit from selecting a subset of outcomes that are comparable across studies, and a common framework for describing narrative interventions. Scant literature exists regarding narrative interventions to assist providers in communication.
BACKGROUND: With the expansion of palliative care, the concept of clinical excellence is worthy of study and has not been described well in the literature.
OBJECTIVE: To apply the domains of clinical excellence, as proposed and published by the Miller Coulson Academy of Clinical Excellence, to the field of palliative care.
DESIGN: Review of the literature to identify episodes of superb palliative care delivered by individuals and teams.
MEASUREMENT AND MAIN RESULTS: In reviewing 821 publications, we found multiple palliative care case reports to serve as exemplars for each of the distinct domains of clinical excellence.
CONCLUSIONS: The domains of excellence are relevant and applicable to the field of palliative care. This article aims to inspire clinicians-and advance the field-by promoting thoughtful reflection on what clinical excellence in palliative care entails.