Journal Mobile

P Levack, D Buchanan, H Dryden, L Baker
Journal Issue: 
Volume 38: Issue 2: 2008




If  hospital  patients  are  to  have  access  to  specialist  palliative  care, specialist  palliative  medicine  must  operate  successfully  in  a  busy  hospital  setting. This paper evaluates prospective data from 3,523 patients referred to a hospital specialist palliative care service over eight years (1999–2006). The number, age and frailty  (determined  by  the  palliative  performance  scale)  of  referred  patients increased  every  year.  The  median  time  from  referral  to  death  was  27  days. Referrals specifically for symptom control doubled (80% versus 40%). The service responded  by  providing  a  shorter,  more  intensive  service:  more  joint  (nurse/doctor)  consultations,  a  300%  increase  in  medical  consultations  and  more discharges  back  to  the  referring  team.  Co-management  between  palliative medicine  and  other  consultants  has  increased,  and  attention  is  focused  on  the management of difficult symptoms. For some patients the referring specialist will lead  management,  while  for  others  with  predominantly  palliative  care  needs, management  will  be  led  by  palliative  medicine  specialists.  For  patients  with  the most complex needs, intensive symptom control and palliative care may be most effectively delivered in a dedicated hospital unit.