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Balancing Consult Team Staffing Levels and Service Commitments (313)
Vol. 39 No. 2 February 2010
Schedule with Abstracts
353
population and the potential uses of interventional pain management techniques. Appropriate candidates for interventional therapy will be identified. Neuraxial drug delivery systems (epidural and intrathecal) for pain management will be discussed, as well as peripheral and autonomic nerve blockade for palliative care. The use of spinal cord stimulation, neuroablative techniques, and neurosurgical techniques for pain control will be discussed. Review of the literature, recommendations, and guidelines by professional organizations and governmental agencies, and consensus of experts will guide the palliative care practitioner in formulating a strategy for consideration of these techniques in patients. The efficacy, potential adverse effects, and complications associated with these techniques will be discussed.
Learners will have an opportunity to estimate staffing requirements for their own program and develop an action plan for integrating their estimates into a strategic plan for program growth.
Domain Physical Aspects of Care
Objectives 1. Define futility in lay, medical, and legal terms. 2. Review actual case law across the United States that addresses concerns of medical futility and the provision of futile treatments. 3. Discuss how to provide guidance for healthcare providers on how to approach cases of medical futility.
Balancing Consult Team Staffing Levels and Service Commitments (313) David Weissman, MD, Medical College of Wisconsin, Milwaukee, WI. Lynn Spragens, MBA, Spragens & Associates, LLC, Durham, NC. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Recognize the impact of palliative care staffing on team health and function. 2. Discuss strategies to match service commitments to staffing levels. 3. Formulate an action plan of team staffing requirements based on national data benchmarks. The growth of hospital-based palliative care has been phenomenal in the past 10 years. Along with this growth, many palliative care programs suffer significant staff burnout. Thus, a common tension for program managers facing program growth is to balance increasing staff workload against the stress of caring for seriously ill and dying patients. Although there is no simple formula to calculate optimal staffing requirements, there is growing body of data to help program managers estimate acceptable workloads for key consultation staff. This workshop will review the available data on palliative care consultation staffing metrics and present different models of clinical care delivery in the context of operational standards for palliative care programs.
Domain Structure and Processes of Care
Is it Futile to Discuss Futility: A Review of the Medical Literature and Legal Precedent (314)? Nadia Tremonti, MD, Wayne State University and Children’s Hospital of Michigan, Detroit, MI. Lynne Prybys, JD RNC Esq, Oakland University, Rochester Hills, MI. (All speakers for this session have disclosed no relevant financial relationships.)
Providing medical treatments that may be futile is a source of moral distress for physicians and other healthcare providers. These cases are often brought to hospital ethics committees and debated widely in the media. Several cases have been heard in the legal court system; however, balancing a patient or family’s autonomous rights to request medical treatment against healthcare provider’s rights to moral integrity and to only provide treatments that reflect professional standards, clinical evidence, and personal values continues to be a very difficult task. This session will introduce the learner to the debate about the definition of medical futility. We will review legal cases and media events from around the country that have addressed this issue. We will also discuss our own institution’s experience through a case presentation of a child with severe neurologic impairments whose family insisted on treatments that the medical team identified as futile. The ethics committee, futile care committee, risk management department, and hospital administration were involved and we will review the challenges that were faced and lessons learned. Though there remains no clinical consensus and no case that has been heard by the US Supreme
Schedule with Abstracts
353
population and the potential uses of interventional pain management techniques. Appropriate candidates for interventional therapy will be identified. Neuraxial drug delivery systems (epidural and intrathecal) for pain management will be discussed, as well as peripheral and autonomic nerve blockade for palliative care. The use of spinal cord stimulation, neuroablative techniques, and neurosurgical techniques for pain control will be discussed. Review of the literature, recommendations, and guidelines by professional organizations and governmental agencies, and consensus of experts will guide the palliative care practitioner in formulating a strategy for consideration of these techniques in patients. The efficacy, potential adverse effects, and complications associated with these techniques will be discussed.
Learners will have an opportunity to estimate staffing requirements for their own program and develop an action plan for integrating their estimates into a strategic plan for program growth.
Domain Physical Aspects of Care
Objectives 1. Define futility in lay, medical, and legal terms. 2. Review actual case law across the United States that addresses concerns of medical futility and the provision of futile treatments. 3. Discuss how to provide guidance for healthcare providers on how to approach cases of medical futility.
Balancing Consult Team Staffing Levels and Service Commitments (313) David Weissman, MD, Medical College of Wisconsin, Milwaukee, WI. Lynn Spragens, MBA, Spragens & Associates, LLC, Durham, NC. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Recognize the impact of palliative care staffing on team health and function. 2. Discuss strategies to match service commitments to staffing levels. 3. Formulate an action plan of team staffing requirements based on national data benchmarks. The growth of hospital-based palliative care has been phenomenal in the past 10 years. Along with this growth, many palliative care programs suffer significant staff burnout. Thus, a common tension for program managers facing program growth is to balance increasing staff workload against the stress of caring for seriously ill and dying patients. Although there is no simple formula to calculate optimal staffing requirements, there is growing body of data to help program managers estimate acceptable workloads for key consultation staff. This workshop will review the available data on palliative care consultation staffing metrics and present different models of clinical care delivery in the context of operational standards for palliative care programs.
Domain Structure and Processes of Care
Is it Futile to Discuss Futility: A Review of the Medical Literature and Legal Precedent (314)? Nadia Tremonti, MD, Wayne State University and Children’s Hospital of Michigan, Detroit, MI. Lynne Prybys, JD RNC Esq, Oakland University, Rochester Hills, MI. (All speakers for this session have disclosed no relevant financial relationships.)
Providing medical treatments that may be futile is a source of moral distress for physicians and other healthcare providers. These cases are often brought to hospital ethics committees and debated widely in the media. Several cases have been heard in the legal court system; however, balancing a patient or family’s autonomous rights to request medical treatment against healthcare provider’s rights to moral integrity and to only provide treatments that reflect professional standards, clinical evidence, and personal values continues to be a very difficult task. This session will introduce the learner to the debate about the definition of medical futility. We will review legal cases and media events from around the country that have addressed this issue. We will also discuss our own institution’s experience through a case presentation of a child with severe neurologic impairments whose family insisted on treatments that the medical team identified as futile. The ethics committee, futile care committee, risk management department, and hospital administration were involved and we will review the challenges that were faced and lessons learned. Though there remains no clinical consensus and no case that has been heard by the US Supreme