Literature Review

Sharp decline in early outpatient palliative care despite HMP workforce growth Clinical Pain Advisor; by Lisa Kuhn, PhD; 4/26/24 While the number of US Medicare hospice and palliative medicine (HPM) physicians has increased sharply from 2008 to 2020, early outpatient access to specialized care declined significantly during this period, with care concentrated in metropolitan and inpatient settings, according to study results published in the Journal of Pain and Symptom Management. Between 2010 and 2020, the number of HPM fellows increased from 141 to 401. However, recent estimates suggest insufficient capacity to meet the demand for palliative care and hospice needs.

How Avow Hospice used triage to boost quality, reduce turnoverHospice News; by Jim Parker; 4/26/24Avow Hospice has implemented a triage system that has resulted in improved quality scores and reduced turnover. The Florida-based provider uses an acuity system that draws data from its electronic medical record (EMR) system to help stratify patients based on their most likely immediate needs. To complement these efforts, Avow also revamped its approach to night time and weekend visits, Rebecca Gatian, COO of Avow Hospice, said at the National Hospice and Palliative Care Organization’s Virtual Interdisciplinary Conference. 

Palliative care nursing: Podcast with Betty Ferrell about ELNECGeriPal Podcast; by Alex Smith, Eric Widera, and Betty Ferrell; 4/26/24As Betty Ferrell says on our podcast today, nurses play an essential role in care of people with serious illness. Who spends the most time with the patient in the infusion center? Doing home care? Hospice visits? In the ICU at the bedside? Nurses. ELNEC (End-of-Life Nursing Education Consortium) celebrates it’s 25th anniversary in 2025. We talk today with Betty Ferrell, who has been a nurse for 47 years, and is the founder and PI of ELNEC.

Across the nation, the fight’s on to protect physician-led careAmerican Medical Association - AMA; by Kevin B. O'Reilly; 4/25/24After helping state medical associations and national specialty societies defeat more than 100 bills to inappropriately expand nonphysicians’ scope of practice in 2023, the AMA is again relentlessly joining its allies in organized medicine to continue the fight for physician-led, team-based care in this year’s legislative session. This intensive and effective advocacy effort has ranged across the country, as the AMA has helped battle scope creep in Alaska, Connecticut, Georgia, Oklahoma, New Hampshire and elsewhere.

Beyond compensation: Culture as a benefit HR Daily Advisor; by G Hatfield; 4/24/24 Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process. CNOs should take a look at their health system’s offerings to make sure they are attractive to new nurses and that they are staying competitive in the industry. During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, spoke about  innovative perks to attract and keep nurses, and how workplace culture and safety play a role as benefits alongside compensation.

The moral compass of medicine: Exploring ethical dilemmas Medscape, by Lambeth Hochwald; 4/23/24 While the ethical conflicts discussed in medical school once focused primarily on patient privacy, end-of-life issues, and conflicts of interest with pharmaceutical companies, today, the list of ethical dilemmas facing physicians has risen to include everything from gender care and vaccine issues to weight loss drug access and abortion regulations in some states. ... So, what happens when a physician’s expertise clashes with local, state, or national politics?

CMS increases hours to 3.48 in final staffing rule McKnights Long-Term Care News, by Kimberly Marselas; 4/22/24 Nursing homes will be required to deliver 3.48 hours of daily direct care per patient under a final staffing mandate issued this morning. A White House statement on the rule [4/22] said that 3.0 hours must be split between registered nurses at 0.55 hours and 2.45 hours for certified nurse aides. The remaining time was not immediately defined by the White House release, and the full rule text was not available.

Mercy Hospital surgeon teaches high school student future of surgical medicine CBS News TV 13 Sacramento, CA; 4/21/24 A unique experience for high school students, taking a step into the world of robotic surgery. Mercy Hospital hosted students to learn the ins and outs of the future of surgical medicine.

Primary and specialty palliative care utilization at a regional Burn center Oxford Academic / Journal of Burn Care & Research; by Zoe Tao, MD, Alexandra Hoffman, BS, Anna Stecher, MD, Niknam Eshraghi, MD, FACS; 4/20/24There is little research informing appropriate specialty palliative care consultation over primary palliative care practice, or the ability of the burn surgeon to perform skills such as effective goals of care discussions. ... There is bias in diverting both primary and specialty palliative care resources toward acutely ill patients and those with less immediate projected mortality may need additional attention.

Terminally ill pediatric patients and the grieving therapist Psychotherapy.net, by Sara Loftin, LPC-S, RPT-S; 4/18/24 A pediatric clinician shares the rewards and challenges of working with terminally ill children and their families. When asked about the favorite aspect of my (dream) job, I could talk for hours. I feel passionate about working in a pediatric hospital setting with chronically ill children and their families. Each day brings new challenges. ... Experiencing the death of a child is the most painful part of my job, and it will never make sense to me although logically, I know this happens. On the other hand, I feel honored to be a small part of the most vulnerable time in a family’s life, and to walk alongside them in their journey of grief and loss. ... It has been impossible for me to not be deeply impacted working in this arena. [This article includes:]

Hospice handoffs may lower odds of Medicare denials Medscape, by Lara Salahi; 4/29/24Clearer communication between primary care clinicians and hospice providers may decrease the number of denied Medicare approvals for end-of-life treatment, according to a small study presented on April 18 at the American College of Physicians Internal Medicine Meeting 2024. Tyler Haussler, MD, acting medical director at  Brookestone Home Health & Hospice in Carney, Nebraska, said he conducted the study. ... CMS requires a "face-to-face encounter" between a physician and hospice caregiver to communicate clinical findings and determine the patient's terminal status. Missing or incomplete documentation of a patient's medical condition remains one of the main reasons the agency denies hospice coverage. 

5 steps to cutting the red tape that adds to doctor burnout American Medical Association (AMA), by Sara Berge, MS; 4/16/24 ... Reducing burnout is essential to high-quality patient care and a sustainable health system. The AMA measures and responds to physician burnout, helping drive solutions and interventions. ... Dr. [Kevin] Hopkins identified the five steps below to get rid of regulatory make-work that interferes with patient care and contributes to physician burnout.

Health care system eats away at the doctor-patient relationship The Boston Globe; updated 4/17/24... The system economically rewards throughput (the number of patients seen per unit time) and procedures rather than the time needed to develop an open and communicative doctor-patient relationship. While a good physician might understand the tests and evaluations that are indicated by a presenting medical problem, the excellent clinician knows which tests and evaluations should not be done. This is primarily ascertained by delving into details of the patient’s physical, psychological, social, family, and economic history. This process, as James highlights, can lead to collaborative and more effective care. ...Editor's Note: This article highlights "Dr. Thea James’s remarkable work at Boston Medical Center in addressing structural inequity in medical care as a means of enhancing outcomes brings up an underlying structural problem across the entire medical care system (“Her health equity message being heard,” April 13, 2024.)