By Karl B. Bezak, MD
Hospice and Palliative Medicine Fellow
Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
Dr. Karl Bezak is a former academic hospitalist at Lankenau Medical Center in Wynnewood, Pennsylvania, and is currently completing his Hospice and Palliative Medicine fellowship. In this blog post, he shares insights about how both hospitalist and palliative care teams work together most effectively.
Background of the Hospitalist Team
Palliative care specialists play an integral role in supporting hospitalists, and improving the quality of care for hospitalized patients and their families. To best partner with our hospitalist colleagues, it is important to understand hospitalist team composition, values, and goals in caring for hospitalized patients. While hospitalist teams vary in size and composition, they are also interdisciplinary, including the hospitalist, nurse practitioners, nurses, hospital-based social workers, and case managers. All team members work together to safely admit, treat, and discharge patients—while aiming to provide high-quality, efficient, and patient-focused care.
Palliative care specialists play an integral role in supporting hospitalists, and improving the quality of care for hospitalized patients and their families.
Drawing from my experience and that of colleagues, hospitalists often value patient care, teamwork, time management, and work-life balance as precious commodities. In a typical day, hospitalists will often manage twelve to fifteen patients with three or more active medical problems, coordinate care with multiple consultants and primary care doctors, keep patients and families updated, and attempt to address goals of care and code status as needed. As patients become increasingly complex, these tasks become more challenging. Hospitalists and their teams work to provide outstanding care for patients and families, in the midst of external pressure to reduce length of stay and optimize quality metrics—all the while attempting to avoid occupational burnout.
We have unique skills, perspective, and experience that allows for collaboration with hospitalist teams.
Palliative care specialists have unique skills, perspective, and experience that allows for collaboration with hospitalist teams, in order to effectively care for the most complex patients and families, enhance workflow, and maintain a reasonable work-life balance.
How Palliative Care Specialists Can Add Value to Hospitalist Teams
1. Provide pain and symptom management recommendations
Hospitalists typically complete residency in internal medicine or family medicine prior to specializing in hospital medicine. As there are no formalized Accreditation Council for Graduate Medical Education (ACGME) requirements for palliative care competencies in either residency, hospitalist clinicians have variable exposure to evidence-based pain and symptom management. When first-line therapies fail to relieve pain and other symptoms, palliative team guidance in complex symptom management can both ease patient suffering and improve hospitalist satisfaction with their ability to provide effective patient care.
Palliative team guidance in complex symptom management eases patient suffering and can improve hospitalist satisfaction.
2. Provide education to hospitalists and their interdisciplinary team(s)
While hospitalist teams bring considerable experience and skill to their work, each clinician’s ability to exhibit core palliative skills varies. Palliative care education from specialists in effective communication, as well as pain and symptom management can take many forms, such as one-on-one interaction with hospitalist teams, through dedicated didactics sessions, presenting at grand rounds, and/or by referring clinicians to CAPC resources. Training empowers hospitalist teams to handle most communication, family support, and symptom management needs, reserving consult requests for more complex cases.
3. Facilitate complex family meetings and clarify goals of care
Hospitalists often care for patients with serious illness who have complex medical and psychosocial needs, long hospital stays, and unclear or unrealistic goals of care—all of which stress hospitalist teams and increase length of stay.
Palliative care team consultation—even late in the hospital course—brings a fresh perspective and specialized communication skills to family meetings, supporting hospitalist identification of patient and family values, and goals of care. Improved clarity often improves communication and coordination of care that may shorten length of stay, a key hospitalist quality metric.
Palliative care team consultation brings a fresh perspective and specialized communication skills to family meetings.
4. Provide continuity of care to patients and families across multiple admissions
Hospitalists have highly variable shift-work schedules—often one-week on, one-week off—that include intense twelve-hour days, seven days a week, sometimes covering a different team each week. This leads to a significant number of handoffs between hospitalists while changing shifts, limiting continuity of care for people living with serious illness. Palliative care teams are often consulted on these patients, and can provide helpful insights, history, and continuity to hospitalists over time. Moreover, when there are pre-existing relationships between the palliative care team and patients and families, this experience and knowledge of prior discussions assists hospitalists in facilitating timely, patient-centered, and goal-oriented care.
5. Improve the resilience of hospitalist teams and enhance the clinical environment
Hospitalists and their teams care for hospitalized patients living with serious illness, most of whom have complex physical, social, emotional, and spiritual needs. Palliative care specialists understand that managing these diverse and complex needs can be exhausting. By utilizing their specialized skillset, they can ease referring clinician moral, emotional, and existential distress. Through debriefing, sharing effective coping strategies, and acknowledging the challenge of caring for these patients—regardless of patient outcome—partnership between palliative care and hospitalist teams demonstrates compassion, improves resilience, and builds esprit de corps in the clinical environment.
Through the above examples, my goal was to highlight the substantial role that palliative care teams play in the lives of our hospitalist colleagues and their teams. With effective hospitalist-palliative care team collaboration, we can grow together as partners in providing high-quality, effective, patient-focused care that benefits both patients and families.
With effective hospitalist-palliative care collaboration, we can grow together as partners in providing high-quality, effective, patient-focused care.
The below resources can help with further hopsitalist-palliative medicine collaboration:
- Hospital Medicine Toolkit, available to all CAPC members, this toolkit can be used by hospitalists to address needs earlier in a hospital stay, minimize late referrals to palliative care, avoid unnecessary readmissions, and more.
- Improving Quality of Care for Seriously Ill Patients: Opportunity for Hospitalists, a recent paper published in the Journal of Hospital Medicine
Don’t have a hospital-based palliative care program? CAPC members have free access to tools and resources, to help get your program off the ground (and succeed once it’s established). Start here.