Palliative Care Consult

Before the first day on service, sign-out should occur from the outgoing member to the appropriate incoming team member (resident to resident, intern to intern).

9:00 AM – 11:00 AM Work Rounds (see old patients, new consults)

11:00 AM – 12:00 PM Attending Rounds

12:00 PM – 1:00 PM Lunch/Conference (Grand Rounds, M&M, CPC)

1:00 PM – 5:00 PM Work Rounds

The Palliative Care Consult rotation is entirely at the Los Angeles General (LAG) Medical Center. Consults any primary inpatient service, including, but not limited to general inpatient medicine/surgery, MICU, SICU, NICU.

The patient population at LAG Medical Center is very diverse, with multiple ethnic and socioeconomic groups represented. The spectrum of these encounters will be from primary presentation of new disease processes to the tertiary care for the patient who is referred for subspecialty care. .

All consults are placed through the phone line or by order or ORCHID and taken down by the team clerk, who records basic information, places the patient on the ORCHID list, and on the board.

New patients are written at the bottom and designated with an "N" for new or "R" for renew. Their information sheet is placed in the hanging folder on the board. The patient is unassigned and available for pickup if there is no team member initial next to their name on the board. Rotators can pick up patients, and will usually follow them with the service attendings, but will occasionally be encouraged to follow with non-MD team members so that they see other styles and approaches to palliative patients.

When the resident gets a new consult, the resident should review the chart to get a sense of the problem then call the team to confirm reason for consult and to ask how the palliative care service can help. This is to avoid several consult pitfalls unique to our specialty.

Consults should be viewed with the following priorities:

• Emergent: Emergent consults must be reviewed faculty within two hours. Review by faculty must occur within 24 hours or sooner if appropriate. Cases should initially be evaluated by residents at the PGY-2 or PGY-3 level. Medical students or PGY-1 housestaff may not see emergency consults unaccompanied by PGY-2 or PGY-3 residents, fellow, or faculty.

• Urgent: Urgent consults must be reviewed and co-signed by fellow and/or faculty within 8 hours. Review by faculty must occur within 24 hours. Consults may be initially evaluated by fourth-year medical students or housestaff of any post-graduate year. Fellows may review and co-sign consultations prior to review by faculty.

• Routine: Routine consults must be seen, reviewed and co-signed by fellow and/or faculty within 24 hours. Consults may be initially evaluated by fourth-year medical students or housestaff of any post-graduate year. Fellows may review and co-sign consultations prior to review by faculty.

Attending Rounds are performed at 11:00 AM every Monday through Friday unless moved by service A attending. The attending should review all of the team's new admissions from the previous twenty-four hours and discuss all of the team's established patients with new, significant developments. Faculty are expected to perform teaching, discussion of pathophysiology, and should use current available studies to aid in diagnostic and therapeutic decisions.

• Rotators should approach all patients holistically in terms of understanding their reason for admission, PMHx, current inpatient reason for admission as well as their current living situation, substances used, how they’re used (ie nasal, IV, oral etc), history of withdrawal as well as any prior MAT (medications for addiction treatment) they have been on and failures or successes on those medications

• Given many of our patients are extremely high risk for unwanted pregnancy, HCV, HIV we also focus on harm reduction (ie clean needles, fent test strips) as well as encouraging testing for transmissible diseases and offering birth control/emergency contraception for pts with child-bearing potential

All recommendations should be directly given to the consulting team via phone or teams