A Three-Step Process to Create a Palliative Medicine Co-Management Model of Care on an Inpatient Hematology Unit (QI814)

Abstract

•Name and discuss strategies to build partnerships between a palliative medicine team and other services.•Identify key metrics and outcomes that support and enhance co-management partnerships. Northwell Health’s North Shore University Hospital (NSUH) campus has a dedicated hematology unit. This cohort of patients is under-represented on our inpatient palliative care service, comprising < 1% of initial consultations in 2016. Given recent recommendations by the American Society of Clinical Oncology about comprehensive cancer care and recognizing the growing need for palliative care in patients with hematological malignancies, our goal was to initiate a concurrent hematologic and palliative care delivery model. Increase the number of Palliative Medicine consultations on the Hematology unit by 100 percent within three months. A three-step process was initiated: inpatient service buy-in and joint workgroup development, concurrent care delivery, and linkage to outpatient partners. The first step was to obtain buy-in with faculty stakeholders at our institution, including Hematology-Oncology leadership. There was immediate support for a partnership. Next, a workgroup was assembled to jointly generate a needs assessment survey to determine how best to assist in the care of these complex patients. We identified key metrics to measure and linked our inpatient service with outpatient care via our Supportive Oncology practice. The five month process culminated in biweekly “screening rounds” with the Hematology team, which were initiated in late June 2017 and have identified high-need patients for consultation. In 2016, our service saw two hematology unit consults per month. In the month of July 2017, we saw thirteen consults (650 percent increase). Through relationship management, workgroup development, and care transition to the community, an inpatient supportive care co-management model for patients with hematologic malignancies was successfully implemented using a three-step process. This strategy can be replicated for other services with complex patients. Future analysis of these metrics will be able to provide valuable feedback to both services. By creating healthcare pathways with an emphasis on Palliative Medicine co-management, we are poised to deliver comprehensive care and measure its impact.