Delivering palliative care in a community hospital: Experiences and lessons learned from the front lines

Objective: To describe an approach to develop a community-centric palliative care program in a rural community health system and to review data collected over the program's first year. Methods: We describe the underlying foundations of our program development including the health system's prioritization of a palliative care program, funding opportunities, collaboration with community supports, and the importance of building a team and program that reflects a community's needs. Data were collected through a program-maintained spreadsheet and a data monitoring system available through the Global Palliative Care Quality Alliance. Results: 516 new inpatient consultations were seen during the first year, for a penetration of 3.7%. The demographics of the patients who received consultation reflect that of the surrounding community. Over 50% of patients seen within the first year died, and hospice utilization at home and within facilities and inpatient hospice units increased. In addition, 79% of the patients seen by the palliative care team had a confirmed code status of do not resuscitate and do not intubate. Conclusions: Butler Health System's approach to development of a palliative care program has resulted in increasing utilization of palliative care services in the hospital. Having hospital administration support, community support, and understanding the individualized needs of a community has been essential for the program's expansion.