The University of Kansas Hospital is a tertiary care academic medical center with a level one trauma center and a regional burn unit with a large Medicare/Medicaid population in addition to private pay/insured patients. For the past seven years, The University of Kansas Hospital has ranked on U.S. News and World Report's Best Hospitals lists.
The University of Kansas Palliative Care inpatient consult service is a fellowship training site for four rotations. The service sees a broad range of patients, from all of the ICU settings (medical, cardiac, surgical, neurosurgical, trauma, burn), medicine and oncology. The team sees an average of 85 new patients per month. Approximately 66 percent of patients on the service are discharged from the hospital alive.
The fellow has significant interaction in the ICUs and gains experience in facilitating emotional and often complicated intra-professional discussions and family meetings. Consults range from patient and family support and education through aggressive trials of intervention to management of the natural dying process on a purely comfort-directed approach. Decision-making process, logistics, and management of patients in removal from artificial life support are also experienced.
There are two rounding teams on service at KU during weekdays. Each core team consists of an attending physician, a nurse and a social worker. The four hospital staff chaplains also support the teams. Physician learners present on the service may include fourth-year medical students, senior residents and fellows, with no more than two learners present at any given time. A variety of nursing, social work, or clinical pastoral education residents rotate on the service additionally.
During rotation with the Palliative Care service at KU, the fellow participates in the daily operations of the interdisciplinary team, seeing new consults as well as followup patients in conjunction with the Palliative Care attending, the rounding clinical nurse specialist, and the dedicated social worker. The fellow is integrally involved in whole patient assessments, symptom management, patient and family meetings, formulation of "goals of care" based treatment plans, and negotiating the medical system to facilitate safe and timely disposition from the acute care environment when appropriate. The fellow maintains continuity of patient care throughout the hospital stay and may be able to continue to follow the patient depending on their discharge disposition; either in fellow outpatient clinic or with home or inpatient hospice. As the year progresses the fellow takes a lead role for his/her patients in formulation of treatment plans, communication with other members of the Palliative Care rounding team as well as the primary team attending, house staff, and other consulting physicians regarding patient care recommendations and plan of care. Increasing autonomy in the second half of the fellowship is accomplished by the fellow serving as the lead physician on one of the inpatient teams, with a faculty member attending providing direct and indirect supervision. Interdisciplinary rounds with the pertinent floor nursing, social work, and care coordination staff as well as ancillary services are performed daily as needed for each patient. The fellow serves in a supervisory role with residents and medical students rotating on the service as well. Finally, the fellow participates in the weekly Tuesday interdisciplinary care team conference where patient care plans are discussed in detail and where the team debriefs on difficult or meaningful events of the week.