October 14, 2005

Palliative care service eases transition process

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Roy Elam, M.D.

Palliative care service eases transition process

The Vanderbilt University Hospital Palliative Care Consult Service was launched in July as an interdisciplinary team working to relieve suffering and improve quality of life for adult inpatients at all stages of illness.

The service helps patients and families through end-of-life questions such as stopping chemotherapy, withdrawing tube feeding and ventilators and ruling out resuscitation in the event of apparent death. It provides vigorous pain and symptom control — including help with problems such as nausea, delirium, depression and constipation — and assists the transition to hospice care and to nursing home care.

“When it comes to having one- or two-hour discussions with a patient and family about palliative care and end of life issues, we have time available that many busy physicians simply don't have,” said Roy Elam, M.D., associate professor of Medicine and director of the Palliative Care Program.

The program also has plans for a research initiative, a fellowship training program and educational offerings for staff, faculty, house staff and students.

Elam said a majority of the patients seen by the Palliative Care Consult Service have a life-threatening illness, but that isn't a requirement for consultation, and he stressed that palliative care has a role at all stages of illness.

In its first eight weeks of operation the service responded to approximately 100 requests for consultation, and during this period VUH doubled its rate of referrals to hospice care, Elam said.

The children's version of the consult service, the Pediatric Advanced Comfort Care Team, was established at the Monroe Carell Jr. Children's Hospital at Vanderbilt in 2003. By now, most of the nation's top academic medical centers have a palliative care service, Elam said.

The members of the consult service are Elam, Jim Bridges, M.D., Ralf Haberman, M.D., Sumi Misra, M.D., Case Manager Virginia Turner and Nurse Practitioner Kathy Mitchell. As needs arise, the service calls in help from social work, pastoral care, clinical ethics and the pharmacy. The service operates weekdays from 8 a.m. to 5 p.m. Patient care teams should use WizOrder to order a consultation. To reach the service by pager call 317-CARE (2273).