Since the inception and development of palliative care in the United States as its own distinct medical discipline in 2006, the number of hospitals with palliative care teams has steadily grown. The Center to Advance Palliative Care currently estimates that about 55 percent of hospitals in California have a palliative care team in place. A recent case at one such hospital – Providence Holy Cross in Mission Hills – exemplifies how a palliative care team, while caring for the patient and their family as a whole, can also collaborate effectively in certain situations to make life possible for others through OneLegacy’s organ donation program.

When an otherwise healthy 37-year-old trauma patient was admitted to Providence Holy Cross, she and her family had every expectation of a full recovery upon admission. When the situation worsened dramatically and quickly, the hospital’s palliative care team was already working with the patient’s family, helping them through the entire process.

According to Marwa Kilani, MD, director of palliative care at Providence Holy Cross, the family was having serious issues understanding and accepting the clinical situation, which was a diagnosis of brain death. She and her team worked closely with the family to help them understand that life support would not bring back their loved one. “When the patient’s family was approached by OneLegacy, our palliative care team was there with them; we were familiar faces to support them through the whole time,” Dr. Kilani said. “It was heart wrenching to see the family grieving, but ultimately it was rewarding for everyone that the family made a decision for the greater good.” Organ and tissue donation in this case helped six people to live new lives.

OneLegacy is the federally designated transplant donor networking serving the seven-county area of Southern California. Katie Curran, donation development coordinator at OneLegacy, said what palliative care truly offers is an integrative way to care for the patient and the family, particularly helping when making end-of-life decisions. “This family was able to say yes to helping others even while devastated with their own tragedy,” Curran said, adding that she and her team work with families to let them know what their options are in such situations.

Rev. Kristin Michealson of Providence Holy Cross’ palliative care team says one of her most crucial roles is to validate what patients and their families are feeling and to make medical language understandable. “I’m an advocate for the family to question what the doctor said or what they mean. One of my main functions is to make sure the family understands the diagnosis and what their options are,” she said. Whatever option the family chooses, Michealson provides appropriate, compassionate support. In this case, the patient had young children, whom Michealson counseled; she also had them draw pictures to keep by their mother’s bedside.

Organ donation cases such as this one ultimately bring a sense of peace and purpose. “It’s a selfless gift,” Michealson said. “For families who make that selfless decision–in the midst of shock and grief to be able to think about other people is absolutely incredible,” she said.

Teresita Charlton, another donation development coordinator at OneLegacy, noted the importance of palliative care in donation after cardiac death. “Based on a recent case experience at one of my hospitals, I found that when working on a donation after cardiac death case, palliative care is essential to the care of the patient before and during the entire OR time until the time of the patient’s death pronouncement. In my experience, the palliative care nurse ensured that the hospital’s Comfort Measure Policy and Withdrawal of Life Sustaining Treatment Policy were being followed. At the same time, she kept in close communication with OneLegacy to help facilitate the fulfillment of the family’s wishes for donation, while also ensuring administration of comfort measures through close communication with the physician. I could not imagine the case without her skillful support.”

The interdisciplinary approach of palliative care allows for collaboration among many care team members–physicians, nurses, social workers, chaplains. This collaboration allows the team to understand the patient’s and family’s values, said Dr. Kilani. “With family conferencing, we determine what’s important to the patient and to the family, and thus have an effect on length of stay in the ICU as well as on ICU mortality,” she said.

The belief in the compassionate, holistic approach at the heart of palliative care is necessary for a hospital administration to implement a palliative care team in the first place. “Palliative care furthers the mission and core of our hospital’s vision, which is to provide compassionate, quality care,” Dr. Kilani said. Ultimately, helping patients through the continuum of care properly has also had a positive financial impact on the hospital. “We have been able to pay for our own program. When there is proper utilization of beds, that saves money. When there is no further ICU level of care, that saves money. When we use med surge or telemetry rather than ICU, that saves money,” she said.

HASC’s 4th Annual Palliative Care Conference is set for Feb. 29, 2012 at Quiet Cannon Conference & Event Center in Montebello. This year’s theme focuses on care transitions and will feature key figures in palliative care program and policy development. The one-day conference is intended for CEOs, COOs, CMOs, CNOs, quality directors, compliance officers and anyone interested in improving the quality of care for patients across the continuum. Register online. For more information, contact either George Mack at (213) 538-0717 (gmack@hasc.org) or Jamila Mayers (jmayers@hasc.org).