A three step process to create a palliative medicine co-management model of care on an inpatient hematology unit.

Abstract

141 Background: 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 for patients with hematological malignancies, our goal was to initiate a concurrent hematologic and palliative care delivery model. Methods: 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. Additionally, we identified key metrics to measure, and linked our inpatient service with outpatient care via our Supportive Oncology practice. Results: The five month process culminated in biweekly “screening rounds” with the Hematology team which were initiated in June 2017 and used as a first step to identify high-need patients for consultation. The workgroup agreed upon performance metrics which included hematologic diagnosis, reason for consult, time to consult from admission, length of stay, documentation of advance directives and goals of care, and outpatient referrals. Conclusions: Through relationship management, workgroup development, and care transition to community, an inpatient supportive care co-management model for patients with hematologic malignancies was successfully implemented using a three-step process. This format and strategy can be replicated for other services with complex patients. Future analysis of the outcome metrics will be able to provide feedback to the Palliative – Hematology services. By creating health care pathways with an emphasis on Palliative Medicine co-management, we are poised to deliver comprehensive care and measure its impact.