DHMC cited for palliative care unit

by Laura Bryn Sisson | 7/18/11 10:00pm

Dartmouth Hitchcock Medical Center will receive a Citation of Honor for its palliative medicine program from the American Hospital Association as part of its annual Circle of Life Awards, the AHA announced July 11.

Three institutions Gilchrist Hospice Care in Hunt Valley, Md., St. John Providence Health System in Detrioit, Mich. and The Center for Hospice & Palliative Care in Cheektowaga, N.Y. received the Circle of Life: Celebrating Innovation in Palliative and End-of-Life Care Award, according to the AHA. The John Stroger, Jr., Hospital in Chicago, St. Mary's Healthcare System in Athens, Ga., and the University of Pittsburgh Medical Center also received Citations of Honor for their palliative care programs.

DHMC's program "epitomizes the goals of palliative care, which [are] to focus on people's quality of life, physical comfort, and emotional and spiritual well-being throughout the course of a serious illness," Dr. Ira Byock, director of palliative medicine at DHMC, said.

The citation was presented to DHMC "in recognition of its strong commitment to inpatient and outpatient palliative care, regional focus and end-of-life and palliative care research and education," according to the AHA press release.

The palliative care program at DHMC has expanded significantly since Byock joined in 2004, he said. The program now has four doctors, three and a half nurse practitioners, specialists in spiritual care, art and writing therapy and several volunteers, which Byock said is unique for a hospital-based program. A chaplain, social worker and volunteer coordinator began working with the program five years ago, according to a pamphlet on the awards published by the AHA.

The breadth and number of staff devoted to the program sets DHMC apart from its peers in palliative care, according to Byock.

"Many hospital-based programs are far less resourced in personnel, and scope of services," Byock said, adding that DHMC has a "more comprehensive" approach to palliative care than its peers because it has a full interdisciplinary team, he said.

"We're really at the forefront of palliative care in terms of our integration, the seamless way teams work together," Byock said.

The palliative care team at DHMC integrates medical care by helping patients to negotiate and coordinate their medical treatments in various other departments, he said.

Patients with life-threatening illnesses must decide which medical treatments' benefits outweigh their risks, and choose how to manage pain and the emotional problems that come with their diseases, according to Byock.

"We complement and extend the services that ICU teams or oncology teams are able to provide," he said. "Most health care is organized around treatment of disease. We make sure the persons with the disease are also tended to in some form."

An outpatient program and support for bereaved families or families with an ill loved one also make DHMC's care standout among hospitals, he said.

Most hospitals now have palliative care in some form, Byock said, but DHMC was an "early adopter." The Palliative Medicine Fellowship at DHMC admitted its first fellow in 2008, and received a five year accreditation from the Accreditation Council for Graduate Medical Education in 2010, according to Byock.

"Training programs quest after five year accreditation because it's a mark that the site visitors have real confidence in the program," he said.

The Jack and Dorothy Byrne Foundation endowed the program, as well as the chair in palliative medicine that Bycok currently occupies, he said.

Currently, the department is conducting national research assessing the effects of palliative care on patients' quality of life, according to Byock. In the next year, palliative care will expand to work with patients waiting for transplants, Alzheimer's patients and patients with end-stage liver disease, according to Byock. Collaboration with intensive care units and the congestive heart failure team will also become more dedicated, he said.

This expansion will involve recruitment of doctors, nurses and social workers, both specialists nationally and professionals within DHMC aiming to shift their careers into palliative care, Byock said.

Regional programs will also expand, as connections with hospices and rural health facilities develop, he said.

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