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Archive for March, 2013

Palliative Care Consults

As some of you may know, our department had a difficult case earlier in the month in which we had trouble transferring a patient near the end of his life to the palliative care unit (PCU) because of procedural confusion about what is possible on overnights.

Gabi Goldberg, the medical director of the Palliative Care Unit, has summarized what our off-hours approach should be for such patients:

“[Mount Sinai does] not have any palliative care physicians present overnight. We have coverage by ADS [the general medical service] and the Rehab PA. If there are patients in the ED appropriate for the PCU, they may be admitted to [the PCU] by the ADS [general medical service] coverage and consulted on by the PCU team and taken on as primary as appropriate the following morning. This is true 7 days a week. In regards to hospice beds, VNS hospice admission nurses are available during business hours +Mon- +Fri with preference for scheduling of admissions in advance. We do allow a 24h window of stay on the PCU prior to hospice admission, but this does not prevent a hospital admission.”

Thus if you have a patient on a +Saturday overnight who would be a good candidate for the PCU and there is a bed available, discuss this plan with the patient’s PMD and the MAPA/MAR and your patient will be rounded on by the primary palliative care service that +Sunday morning. Let me know if you have any further problems.

The palliative care fellow should also be called if you think there’s a patient who’s appropriate for the PCU, even on weekends and in the evening. They need to be involved, for a variety of reasons. Confirmed with Gabi Goldberg.


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