Hospital Palliative Care Team

Guidelines and Suggestions for those Starting a Hospice/Palliative Care Service, 3rd edition

Derek Doyle, OBE, MD

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Hospital Palliative Care Team

Hospital Palliative Care Team (HPCT) –or consultation service– develops in response to the need for expert palliative care. The personnel for a consultation team can be simply a nurse or physician alone or combined with pharmacist, spiritual care or social worker. Those planning a consultation service should not be discouraged by lack of numbers at the outset. Special interest and expertise are essential, however.

Patients and families are seen in consultation only and the HPCT does not assume responsibility for providing care, despite the frustrations inherent in the inability to 'control' patient care. This is the best model if resources are limited or institutional needs minimal e.g., a small local hospital with no oncology service and for a 'start-up' palliative service. Funding is still required and should be arranged before any such service is started.

Once the service is established it is usually found that much time is spent advising on patients who are in the same unit as the one the team has been called to. Patients and families appreciate the extra time and expertise, do better and credibility produces more referrals.

The HPCT may be the contact point for Community Palliative Care Services if these are available and one team member should lead in this. If this is the case a HPCT can facilitate smooth transfer to hospital from home and vice versa.

Advantages HPCT over a dedicated HPCU

Disadvantages of a HPCT

Problems and disappointments

Some examples of problems and disappointments associated with a service may illustrate this:

Before planning a HPCT

For whatever reason you are considering starting a HPCT there are essential preliminary tasks:

In summary, a HPCT is worth considering when there are not the resources to start and operate a bedded unit. However, it must be remembered that the members of the HPCT:

Future development of the HPCT may include:

It is difficult to factor in all of these from start-up, but they should be considered as the unit develops expertise which they can share.

Groups contemplating starting such a service are often daunted by the complexity and expertise of services whose personnel they meet at seminars and on websites they visit. Some are tempted to feel it would be less threatening to start a free-standing unit/hospice, remote from the frenetic, sometimes aggressive atmosphere of a tertiary referral university teaching hospital. Remember others have been in the same position and it was no easier than now. However, it was worth it.

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