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.