Lilian and Benjamin Hertzberg Palliative Care Institute
Palliative Care Consult Service Rotation
Palliative care provides patient-centered treatment for seriously ill hospitalized and ambulatory patients helping them manage the distress of a serious illness. Palliative care focuses on symptom management, enhancement of function, physical comfort, quality of life, and psychosocial support and communication about the goals of medical care. We provide support for the patients as well as their families. Geriatrics and hematology/oncology fellows are required to rotate on this service because palliative care precepts and skills are integral to physicians who care for these patient populations. Mount Sinai's 3rd year medical students on their Geriatrics rotation are required to spend one week on the palliative care service to learn about pain management, basic communication skills and advance directives. In addition, 4th year medical students and housestaff are invited to participate on our service through elective rotations.
There are 2 interdisciplinary teams on service at any one time. Each team includes an attending, fellow, nurse practitioner, and 1-2 medical students. We have a social worker, chaplain and massage therapists who see patients on both teams. All new consults are received by the triage nurse or nurse practitioner who assigns the new patients to one of the two palliative care teams. The fellow or resident and the palliative care attending see all new consults on the day of the request. The patients are seen daily to follow-up on treatment recommendations, symptom management, and communication with the patient and their family. Cases which are particularly difficult or of broader interest are presented at the weekly interdisciplinary Clinical Meeting held Tuesdays at 11 AM in Annenberg 10-30.
- Treatment of common symptoms (physical and psychosocial): Pain, dyspnea, nausea, delirium, depression, constipation, anxiety, existential suffering and other symptoms seen commonly in association with serious illness.
- Broaden understanding and appreciation of psychosocial issues and impact of illness on patient and caregiver: Loss, grief, bereavement.
- Understand NY State Law, end-of-life decision – making, ethical principles: Self determination, decisional capacity, health care proxies, DNR, surrogate decision making, withdrawal and withholding of life-sustaining treatment including decisions around nutrition and/or hydration, and risk/benefit ratio of medical treatments.
- Enhance communications skills with patients, families & colleagues: Lead family meetings intended to discuss and decide about the goals of medical care,deliver "bad news" and support patients/family afterwards, discuss prognosis and plan of care for a range of diagnoses and patient/family preferences. Discuss and practice cross-cultural issues in palliative care and end-of-life care.
In-Patient Consultation Service
Most patients are seen in consultation. We continue to follow as consultants until the patient leaves the hospital or our services are no longer needed. Transfer or admission to the in-patient palliative care team as a primary patient is appropriate for patients with difficult symptom management issues or those for whom a change in care setting is needed to support a shift in the goals of medical care.
Communication with Our Colleagues
The attending of record for a given patient must make a referral or agree to the referral. Prior to seeing the patient, the attending should be contacted to confirm that s/he would like us to see their patient, identify important issues to address, and clarify our team's role in communicating with the patient and/or the family around care. It is important to remember that the primary attending may have a long and strong prior relationship with the patient and family. As a consultant, our primary duty is to the attending of record. We also frequently provide "palliative care" to our colleagues.
All recommendations documented in our consults should be communicated verbally with the patient’s primary medical/surgical team. All efforts should be made to involve the primary team in any family meetings that are scheduled.
Fellowship Academic Coordinator
Brookdale Department of Geriatrics and Palliative Medicine
One Gustave L. Levy Place
New York, NY 10029-6574