Calvary Hospital celebrated 10 years as a hospital within a hospital at Lutheran Medical Center in Brooklyn, N.Y., with a conference geared toward palliative care, hospice and end-of-life services. The Oct. 28 conference at the New York Marriott at the Brooklyn Bridge was an all-day program that included plenary sessions and workshops that covered the many aspects of palliative care and its benefits.
Common sessions included a historical perspective of palliative care at Calvary and a discussion on when and how to refer patients to palliative care services. The conference also offered 14 presentations on topics including symptom management and bereavement support for young children and adolescents.
Patricia Caffrey, RN, MSN, administrator of Calvary’s Brooklyn satellite, and Irina Makarevich, MD, medical director at the site, hosted a workshop called “Building a Palliative Care Unit in an Acute-Care Hospital.” The workshop focused on the creation and maintenance of Calvary’s Brooklyn satellite and how other hospitals can institute similar units at separate sites or within their own facilities.
Hospital within a hospital
Caffrey discussed the advantages of palliative care units. “It not only enhances the quality of care, but we’ve also found it offers financial savings, has increased staff and patient satisfaction and has given us a competitive edge in the market,” she said.
Palliative care can be delivered in a number of ways, Caffrey said. Models include care through a consultation service team, a dedicated inpatient unit, hospice services, a combined hospice/palliative care program or via outpatient services.
Calvary’s satellite is an independent unit within Lutheran Medical Center in Brooklyn. Caffrey said it was a bit tricky putting a satellite unit 25 miles away from the main hospital, so they decided to have the exact same model as in the Bronx. “Once that decision was made, we then had to figure out how to support that,” she said.
Calvary rents the space from Lutheran, and all of its clinical services are rendered by Calvary staff. “All of our staff are Calvary employees and are responsible to our Bronx office,” Caffrey said. “We do contract some services out to Lutheran, including lab services, food and linen services and environmental care [services].”
Pharmaceuticals are ordered from Calvary’s Bronx campus. There is a cabinet in the unit that houses medicine for anticipated emergency use.
The satellite uses surgical consults on staff at Lutheran, although, Makarevich pointed out, they don’t have to be on staff at the host facility. “They just have to have consultative privileges there,” she said.
Cost of care
One deterrent to offering palliative care services may be financial, Caffrey said. To determine costs, she suggested using the cost avoidance calculator provided by the Center to Advance Palliative Care at www.CAPC.org. The center’s website offers information on building a hospital-based palliative care program and provides an overview of financing services.
Caffrey reminded attendees that types of services offered must be a consideration. “Determine if you want to offer services like transfusions, palliative radiation and nutritional support,” she said.
Caffrey and Makarevich ended their presentation with a warning: Be careful what you wish for. “We’re 10 years in, and we need more beds,” Makarevich said. “The need has outgrown capacity.”
Citing statistics from the New York City Department of Health cancer registry, Caffrey said the number of adult cancer patients in NYC has grown exponentially. “It’s heartbreaking to me to not have a bed for someone,” she said.