Palliative Care

Hospice/Palliative Care Instructor

This is a one-year position in Family Medicine, serving as Hospice/Palliative Care Instructor for the Department of Family Medicine at Oregon Health Sciences University.  The Instructor will report to the Fellowship Director, to the Vice-Chair of Academic Affairs, and to the Chair of the Department of Family Medicine. The Instructor will have responsibilities in patient care, teaching, administration, and self-education.

Goal

Provide the Fellow with the foundation to be successful as a Hospice Physician, and/or as a resource for non-hospice palliative care issues in the settings of inpatient care, GIP care, Home Care, Nursing Home care.

Objectives

By the end of this Fellowship, the fellow should possess the following knowledge and skills, by area of study/ rotation:

Hospice

• Understand how to participate in an IDG meeting

• Understand how to supervise nurses in a nurse driven model of    care

• Understand how to make nurses better clinicians

• Understand the COPs, LCD’s and all hard and fast rules and    subtleties of hospice eligibility under Medicare guidelines

• Understand the goals of a home visit:
• •  Assess eligibility 
  • Assess and possibly augment nurse management 
  • Educate family and caregivers

• Make at least one home visit with other members of the team (RN, Chaplain, Social Worker, Volunteer, HHA)

Inpatient Consultant in Palliative Care

• Learn how to be an effective and valued consultant 
• • For the patient 
  • For the family 
  • For the service requesting the consultation 
  • For the hospital 
  • For the community
  • • Home Care
      
    • Nursing Home
      
    • Hospice

• Learn how to hand off patient care to other resources (above)

• Learn how to keep in touch and potentially how to supervise/ advise after handoff

• Learn the Palliative Care “procedure,” namely 
• • Identification of who is family 
  • Respectful and orderly interaction with patient 
  • Respectful and orderly interaction with family 
  • Discovery of methods of decision-making 
  • A respectful conversation with decision makers about goals of care 
  • An orderly conversation with managing team about goals of care 
  • Specific recommendations about 
  • Goals of care 
  • How to achieve goals of care 
  • Specific recommendations for symptom management 
  • Follow-up

• Learn how to withdraw treatment

•  Care for patients and their families in this setting

General Inpatient Hospice Care (GIP)

• Learn how and why patients are transferred to GIP 
• • Symptoms out of control 
  • Imminent death
    
  • Unsafe conditions in home care

• Learn the financing and regulatory issues concerning GIP

• Learn the documentation requirements of GIP

• Understand the team model in GIP

• Learn what can be done in a GIP setting that cannot be done at home

• Learn the Medicare regulations regarding GIP

• Care for patients and their families in this model

Skilled Nursing and Rehabilitation Center:

• Understand regulatory requirements regarding admission to and continued care in a Skilled Nursing Facility (SNF).

• Discuss the common problems associated with acute care discharge/ SNF transfer.

• Understand the modalities of rehabilitation and how rehabilitation evaluated.

• Understand the transition from restorative care to custodial care and how palliative care or hospice care is integrated into this transition.

• Understand the financial and regulatory issues in play regarding hospice or palliative care in Nursing Homes

Patient Care Responsibilities

• Will act as the attending physician on the OHSU Family Medicine Inpatient Service for two to four weeks. The direct supervisor will be the Vice-Chair of Clinical Affairs in Family Medicine. He/she will not be required to take primary jeopardy calls.

• Will work in the Family Medicine Clinic on average four half days per week, including one evening clinic session, providing direct patient care. He/she will participate in the call schedule for their clinic.

Educational Responsibilities

• Will be available to precept medical students, including for the Principles of Clinical Medicine (PCM) preceptorship, family medicine clerkship, or subinternship.

• May participate as educator within both resident and student programs. This includes resident conferences, and student learning sessions including OSCE’s, GOSCE’s, patient management rounds, Primary Care Clerkship presentations, clerkship seminars, and PCM small groups.

Administrative Responsibilities

• Will participate in Wednesday AM faculty meetings, including faculty development sessions (7:30-8:30 AM).

• Will participate in Hospice Inter Disciplinary Group Meetings weekly while on hospice rotation Wednesday 9 AM – 1 PM

• Will participate in Inpatient palliative care planning meetings while on Palliative Care Consult rotation (Thursday 8AM – 9AM)

VI.  Self Education/Research

• Will be allowed to attend CME activities, which relate to Hospice and Palliative Care and which are consistent with the goals and objectives of the position. The Department of Family Medicine will support this educational mission. The Department will pay reasonable tuition expense. Travel and lodging will come out of the Fellow’s CME Budget.

• May pursue another scholarly endeavor of his or her choice during the academic year. The Fellowship Director, Vice-Chair and Chair of Family Medicine will approve this activity.

For further information about our Palliative Care fellowship please contact:

Eric Walsh, MD - Palliative Care Fellowship Director

Eric Walsh, MD

Director of Palliative Care Fellowship