Asa Honors Two California Innovations in Palliative Care
2008 Healthcare and Aging Awards
"Most patients are in the hospital due to a health crisis. This crisis forces confrontation with the reality of illness and the decisions that need to be made about care," said Susan Stone, an emergency room (ER) physician who directs Palliative Care Consult Service (PCCS), created in 2006 by the Healthcare Medical Center Network of Los Angeles County and the University of Southern California (LAC+USC Healthcare Network). PCCS provides inpatient-based consultations for vulnerable individuals, such as homeless people or elders with very low income, who frequently enter an ER with dire health status.
PCCS is one of two innovative California programs in palliative care to receive 2008 Healthcare and Aging Awards from the American Society on Aging (ASA) during the organization's recent national conference in Washington, D.C. ASA's Healthcare and Aging Network presents the awards, in collaboration with Pfizer Medical Humanities Initiative. Now in its 10th year, the awards program recognized a total of six outstanding programs from throughout the United States.
At PCCS, Stone explained, the palliative care service "provides a smooth transition for patients between the hospital and appropriate services, such as hospice, homecare or nursing home." However, she commented, "Starting any new program is a challenge, especially in a large county institution, such as the LAC+USC Healthcare Network." The county's joint facility with the USC Medical Center, a collaboration dating back to 1885, is the largest nonprofit academic institution in the United States.
PCCS is county funded and serves as a safety net, Stone said. She felt it was important to include palliative care in the county health department budget rather than relying solely on grant support. Integrating the program with hospital case management staff has enabled PCCS to place patients based on their needs, in nursing facilities with hospice care or skilled nursing facilities, for example. "We care for a large number of homeless patients who would otherwise die alone and on the street," she said.
Stone recalled that her first hurdle in gaining acceptance of the program within the large LAC+USC Healthcare Network bureaucracy was showing that the program could provide a measurable impact. She added that despite limited funds, PCCS was able to show that it could avoid costs, decrease length of stay in acute-care beds, and improve patient and family satisfaction. Among other benefits, the program has measurably improved patient outcomes through expert pain and symptom control; expedited communication and decision-making for patients, family members and healthcare providers; and increased coordination among healthcare providers.
OUTREACH TO STAFF
Convincing facility staff to include such interventions in the busy ER was another challenge, Stone said, "but this was overcome by the team's presence in the wards, meeting and working with the providers and staff on various issues. We have worked hard to include all staff in education and patient conferences."
The healthcare network serves patients from diverse ethnic backgrounds (67% Hispanic, 14% black, 12% white, 7% Asian), socioeconomic levels and cultures. In its first year, PCCS has served about 700 patients, consulting with them and their families on a full range of endof-life care issues, from symptom management to advance directives and referral to hospice services.
A DAY WITH PCSS
"In the course of a day at the hospital," Stone said, "we may see a prisoner on the jail ward with advanced cancer and work to obtain a compassionate release while managing pain and emotional distress. Then we may see a patient from El Salvador who is non-English speaking but requires assistance with discussing goals of care. We care for patients with advanced AIDS, cancer, heart failure or liver failure in a single day. …