Becker's Clinical Quality & Infection Control

Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. 21 Dr. Meier adds that as CMS' Value-Based Purchasing program continues to emphasize quality metrics and patient satisfaction measures, palliative care becomes a natural offshoot. eventually expand to become a home-based model, Dr. Meier says, and hospitals that practice patient-centered medical homes and accountable care organizations are on the right track. However, Dr. Contreras of HackensackUMC says hospitals that invest in palliative care programs today must keep the specialty's goal in mind: to put patients' wants and needs first and to guide them through comfortable care coordination. The result could lead to improved clinical outcomes, the easing of burdens on staff, increased retention, increased peace of mind for patients and their families, and finally, improved resource utilization. "Transition planning recognizes the needs of patients, families and the community. We need to improve capacity and flow and make beds available for people who really need to be in the hospital, like those who need a bone marrow transplant or an operation," Dr. Meier says. "The home is much better for most patients with multiple and complex conditions or any serious illness, who are usually more vulnerable, older people. Hospitals are the worst places for them because it increases the risks of hospital-acquired infection, mortality and other adverse-outcome measures." "When starting palliative care, you make the argument that you're improving patient satisfaction, improving quality of care, improving bedside care and then discuss, by the way, there might better resource allocation as well," Dr. Contreras says. Overall, the number of hospitals with palliative care programs has risen rapidly over the years. The Joint Commission's Advanced Certification Program for Palliative Care, which Dr. Risser and Dr. Contreras have gone through at both of their hospitals, started in September 2011 and is growing. Dr. Meier says the number of hospitals that have recorded the presence of a palliative care team has more than tripled over 10 years. In 2000, roughly 500 hospitals had a palliative care program, and in 2011, that number ballooned to more than 1,900. Palliative care programs also tend to be more common in larger, tertiary care hospitals, whereas smaller rural hospitals and some safety-net facilities are late adopters, Dr. Meier says. How to formulate the right program Because palliative care is still growing as a patient specialty — and involves several challenges — building the right program takes a lot of continuous effort and attention. Here are four basic steps any hospital leader must consider before the organization starts a palliative care program. Identify a palliative care champion. Dr. Contreras says every hospital-based palliative care program needs a leader who has experience in understanding how a multidisciplinary palliative care program functions. Dr. Risser adds that at Regions Hospital, hospitalists were the largest champions of palliative care, and they led the charge to become a "transdisciplinary" team, as well as multidisciplinary. "Transdisciplinary is the fact that any given practitioner does not stay entirely within the bounds of his or her title, and there is a sharing of responsibility," Dr. Risser says. "Physicians may end up doing some spiritual triage, and chaplains may sit in on care coordination. That is really part and parcel of a high-functioning team: sharing responsibility of getting the story of the patient and getting a care plan that makes sense for that person." Assemble a committee and team to educate stakeholders. After a hospital is able to identify a palliative care leader or leaders, it must put together a committee to identify the appropriate stakeholders, Dr. Contreras says. Educating these stakeholders, leadership, patients and the community at large about what palliative care services provide is essential to get a program off the ground. "Education is a big part of this," Dr. Contreras says. "Palliative care is a service that works in concert with integrated patient care at any level, in harmony with what the patient wants and what the doctor believes the treatment plan should be. It's about respecting the values of patients and guiding them through what can be a very daunting process." Expand palliative care to home settings. When hospitals are able to craft their palliative care programs within their walls, they must be able to reach out to their patients who can be more effectively and safely cared for at home, Dr. Meier says. Instead of a patient calling for 911 or asking a relative to take them to the hospital, the hospital or health system should dispatch a palliative care team member to the home. Palliative care will Focus on quality and certification. The Joint Commission and CAPC have become the main organizations to provide hospitals guidance on their palliative care endeavors. When it comes to establishing the right palliative care quality, Dr. Meier says NationalConsensusProject.org, a project of all major U.S. palliative care organizations, serves as a platform for hospitals to reach standardized quality guidelines, which is the next step for the movement. "The next 10 years have to be about quality and standardization of guidelines," Dr. Meier says. "Just like you have a stroke program, you have to meet quality guidelines. We need to improve penetration and quality in the next 10 years, and we have to bring doctors on board." n Top 10 Most Common Sentinel Events By Sabrina Rodak  In 2012, The Joint Commission reviewed a total of 901 sentinel events. The 10 most common sentinel events reviewed by The Joint Commission in 2012 include the following: 1. Unintended retention of a foreign body 2. Wrong-patient, wrong-site, wrong-procedure 3. Delay in treatment 4. Suicide 5. Op/Post-op complication 6. Fall 7. Other unanticipated event (includes unexpected additional care/extended care and psychological impact) 8. Criminal event 9. Medication error 10. Perinatal death/injury The Joint Commission noted, "The reporting of most sentinel events to The Joint Commission is voluntary and represents only a small proportion of actual events. Therefore these data are not an epidemiologic data set and no conclusions should be drawn about the actual relative frequency of events or trends in events over time." n

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