New Hanover Palliative Care Consultation Services Program

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In 2002, the Duke Endowment awarded a three-year grant to support the implementation of a Palliative Care Consultation Services Program at New Hanover Regional Medical Center. At that time, many regions of North Carolina were offering hospice and pain management programs, however the concept and practice of providing integrated, hospital-based palliative care services through multi-disciplinary teams was just beginning to emerge. The End-of-Life EduCare Program, previously funded by the Duke Endowment, completed much of the initial education and planning that provided for the development of the hospital based palliative care program. The EduCare Program developed initial curriculum and provided education regarding palliative care to physicians, medical residents, nurses, nursing assistants, clergy, social workers and other caregivers.

The Program now provides immediate access to a multidisciplinary palliative care team offering consultation to patients, families and primary caregivers in order to allow a better understanding of the patient's condition and treatment options. Patients and family members are engaged as partners and members of a comprehensive treatment planning team. Resources for counseling and related services are coordinated and continuity of care is achieved as patients are discharged from the hospital to the home, nursing homes or other providers. Physicians and other health care providers have noted a change in culture within Intensive Care Units and other departments throughout the hospital as patients are now routinely screened for spiritual, emotional, psychosocial and pain management needs.

The program's acceptance within the medical community is evidenced by the rapid rate of growth since its inception. In 2002 the program was initiated and a total of 279 palliative care consultations were provided. By the close of the 2005 fiscal year, the program is projected to provide over 4,600 consultations annually. Additionally, the program has documented outcomes including a reduction in the average length of an inpatient stay of 1.6 days, a reduction in treatment costs of approximately $1500 per admission as well as increased patient, family and physician satisfaction scores. Other outcomes include an increase in the number of patients and family members who have participated in Advanced Care Planning and established directives for their future care.

Since the development of the original program model in 2002, the program has extended to include hospitals, nursing homes and additional hospice programs in neighboring counties. Additionally, program staffs have worked with providers in other regions to share their experiences, program models and time in consulting with other North Carolina communities and neighboring states who have since replicated the program in their own community.