The Palliative Care Consultation service was started in 1993 and currently sees 70-90 new patient consults per month from all hospital services. Fifty percent of patients have cancer as the primary diagnosis, the next most common diagnosis is a neurological disorder (dementia, stroke, Parkinson's disease, neurologic trauma). The remaining consults comprise one or more chronic organ system diseases, trauma, or post-operative complications. The most common reasons for referral are pain/symptom management and assistance in establishing the goals of care.
There are two separate consultation teams to manage the patient volume, each with an average daily census of 8-12; each team has a physician, nurse, and one or more student/resident/fellow trainees. The clinical psychologist sees patients and/or families from both teams in need of psychological diagnostic or counseling services. The team provides training for 3rd and 4th year medical students, Internal Medicine residents, Pain Clinic and Oncology fellows, the Palliative Care Fellow, and advance practice nurse trainees.
The consultation service works closely with each of the Internal Medicine, Oncology, Neurology and ICU teams for early patient identification. A new screening process is being piloted to facilitate both in-hospital goal setting and long-term advance care planning for Internal Medicine and Neurology patients.