Resources For Physicians

Who may benefit from a palliative care referral?

Based on physician assessment, any patient with an advanced and/or life-limiting illness may benefit including, but not limited to:

  • Advanced cancer (metastatic/recurring)
  • Advanced COPD
  • Stroke (with decreased function of at least 50%)
  • End stage renal failure
  • ESCHF or other heart disease
  • Advanced dementia
  • AIDS
  • Advanced liver disease
  • ALS or other degenerative neurological disease.
  • Debility patients with multiple ER visits/admissions for UTI/dehydration/malnutrition/decubitus.
  • Patient in the ICU setting with documented poor progress.
  • Patient has prolonged stay in ICU and/or transferred from ICU to ICU setting without evidence of progress.
  • Team/patient/family needs help with complex decision-making and determination of goals of care.
  • Patient has frequent visits to ED (>1/month) for the same thing.
  • Patient has prolonged stay (>5 days) without evidence of progress.
  • Patient has unacceptable level of pain or other symptom of distress for over 24 hours.

What types of services are employed to assist patients?

  • Assistance with advanced directives/identification of health care proxy
  • Symptom management
  • Assistance with clarification of legal and ethical considerations
  • Coordination of family conferences to enhance communication with the healthcare team concerning treatment options, prognosis and goals of care.
  • Education and preparation for time of death
  • Emotional adjustment, grief and bereavement support
  • Clarification of goals of care
  • Adjustment to advanced disease diagnosis and prognosis
  • Assistance with decisions about life sustaining treatments
  • Spiritual and cultural support
  • Life completion goals and tasks
  • Education and preparation for time of death

How do I make a referral?

  • The need for a palliative consult can be identified by many sources:  attending physicians, residents, nurses, family members, patients or social workers.
  • A palliative care consult requires a physician’s order.  If the referral need is recognized by the healthcare team, patient or family member, the unit-based nurse on duty notifies the attending physician of the need and requests an order for the consult.
  • If the attending physician agrees to a palliative care referral, a consult order needs to be entered into EPIC.