Circles of Influence 2014

Organization: Baylor Health Care System Supportive and Palliative Care Services, Dallas, TX. Innovation highlights were its ambulatory palliative care, supportive care focus, and system cultural transformation.

Organization: OACIS/Palliative Medicine at Lehigh Valley Health Network (LVHN), Allentown, PA. Innovation highlights cited for the OACIS/ Palliative Medicine program were the innovative community-based palliative care service, the dual leadership structure and the utilization of a time bank to meet the needs of patients and families.

Recent Achievements:

• OACIS/Palliative Medicine is integral to the network and part of the FY15 and FY16 LVHN mission goals
• The program successfully advocated within the network to add social work positions to its home-based and inpatient services
• There has been significant growth, especially in the inpatient consult service, which led to the addition of clinical and support staff
• Operations of the outpatient clinic service are slated to expand from one to five days a week
• Organizations around the country have been interested in learning from the OACIS/Palliative Medicine experience with providing specialty palliative care services in the home
• Team members have been invited to contribute their technical expertise to national-level efforts to develop community-based palliative care programs
• Several members of the team have presented at national meetings and contributed to publications on palliative care in different settings

Award Impact: Receiving national recognition for its work through the Circle of Life Award was a great honor for the OACIS/Palliative Medicine team and Lehigh Valley Health Network. It validated the dedicated efforts by many and over many years to envision, design and execute a high quality palliative care program across the continuum. It especially emphasized the crucial role home-based palliative care plays in addressing the needs of seriously ill patients and their families who live in the community and struggle to gain access to the care and coordination of services they require to achieve the best possible health status and quality of life. The Circle of Life Award is an ongoing incentive to continue to build a first rate program and contribute to building a solid evidence base for palliative care through collaborative learning with other organizations.

Organization: Yakima Valley Memorial Hospital and Foundation, Yakima, WA. Innovation highlights were its community partnerships, rural outreach, and spiritual care and leadership.

Recent Achievements:

• Affiliation in 2016 with Virginia Mason Health System: The hospital and all associated primary and specialty care clinics are now branded as Virginia Mason Memorial. Our affiliation allows our organizations to share best practices.        
• Change in structure, creating Compass Care: Compass Care is the name given to Virginia Mason Memorial’s Care Line for Advancing Illness and End-of-Life Care, which brings together Home Health, Palliative Care, Hospice, Clinical Ethics, Bereavement, Advance Care Planning, Critical Incident Stress Management, and Spiritual Care. The care line has a leadership structure, service oversight, and a community board responsible for raising funds (alongside the Memorial Foundation).
• Implementation of The Surprise Question (“Would you be surprised if this patient died in the next six months?”) in hospital electronic medical record: Every physician admitting a patient to the hospital is asked The Surprise Question. If the physician clicks the YES box, the admission continues; if the physician clicks the NO box, an order is placed for a palliative care consult by the Inpatient Navigation Team. We are the first organization to implement The Surprise Question as a standard of care for all departments within the hospital.
• The creation of an Inpatient Navigation Team: This inpatient palliative care consult team is comprised of four hospital chaplains and two social workers. When a patient is deemed palliative or hospice-appropriate, an Inpatient Navigation Team member meets with the clinical team, patient and appropriate family members, to determine what the patient knows and understands, what the post-inpatient stay goals of care are, and what resources for area palliative care programs the patient may be interested in.
• Change in makeup of Outpatient Palliative Care and Hospice: We added fifteen social workers to Compass Care; these social workers are cross-trained throughout Compass Care services and begin consults for palliative care, hospice, and the Inpatient Navigation Team; one-third of our now 20 social workers have gained their licensure. In January of 2016, the hospice census was 88 and the palliative care census was 100; today, the hospice census is 150 and the palliative care census is 248, increases of 70% and 148% respectively.
• Advance Care Planning: Virginia Mason Memorial collaborated with Aging with Dignity several years ago and has now purchased nearly 80,000 copies of Five Wishes, which have been distributed to our community. We have trained facilitators to provide presentations to community groups, senior events, church gatherings, families in homes, and patients in clinical settings. The facilitators are social workers and chaplains that have studied advance care planning in Washington State and are able to address issues of Durable Power of Attorney for Healthcare, Living Will, POLST Form, medical decision maker confusion, and other critical areas.
• Adding to the Inpatient Hospice Unit: Community engagement and fundraising allowed Virginia Mason Memorial to build onto their original 12-bed Cottage in the Meadow inpatient hospice facility (first built in 2011 and opened in 2012) in an effort to reach the maximum bed number of 20; this wing was opened in August, 2017. For the Cottage expansion, 423 community donors raised $4,608,558:
  • $3,546,685 for the building
  • $561,873 for program expansion
  • $500,000 for the endowment
• Heart Specialist Liaison to Palliative Care: Adding a heart-specialist nurse to the palliative care team in 2017 allows an extra layer of care for heart failure patients being discharged from the hospital, as this nurse follows them in the home as they receive other services. In the first seven months after hire, 30-day readmissions for this population went from over 20% to zero; one year after implementing this position, 30-day readmissions for this population are currently 4% (this nurse attributes this “high” number to the fact that she has over 100 patients on her active census).
• End-of-Life Extubations: In an effort to provide the best comfort possible for patients, and to reduce complicated grief and post-traumatic stress for families, end-of-life patients on life support in the intensive care unit and their surrogates are offered the opportunity to be transferred to the Cottage in the Meadow for end-of-life extubation. Through innovative work between hospice and the intensive care unit staff, physicians, and respiratory therapists, we have moved over 50 patients to the Cottage for end-of-life extubation.
• We Honor Veterans: We are currently applying for Level 4 of the We Honor Veterans program. With current research, and our discharge data, showing that veterans typically have a hospital length of stay one day longer than non-veterans do, we have an objective to identify veteran status earlier in the hospital admission process.
• Critical Incident Stress Management: We created a team that was trained in Critical Incident Stress Management, the program that provides crisis intervention and disaster behavioral health services to emergency response professions that respond to crises. Our team is deployed whenever a traumatic situation arises in any of our organization’s departments (approximately 2,800 employees). They provide a one-hour critical incident debriefing. This team has helped team members identify coping skills and seek more resources to work through grief, ultimately leading to increased employee retention and better satisfaction at work.
• Increasing Volunteer Involvement: Compass Care currently has 120 volunteers and we are actively seeking to increase that number to 150-170. Volunteers provide support either in the home or at Cottage in the Meadow. They provide respite care in the form of compassionate friendship and emotional support while family members fulfill other obligations or need a break from caregiving, they do light housekeeping, run errands, provide medication delivery, and some are quilters who make the quilts that each patient receives at Cottage in the Meadow.