In partnership with community-based Pathways Hospice, Stanford Health Care has created a dedicated inpatient unit on B1 to provide hospice care for patients who require advanced medical care to frequently titrate medications to relieve symptoms and control pain. The inpatient hospice unit is staffed by members of the Stanford Palliative Medicine team in addition to nurses on B1 who received advanced training in providing comfort care. These medical professionals work together with Pathways medical and social support staff to care for patients who have decided to focus exclusively or primarily on quality of life rather than on life prolongation or curative treatments.

"The hospice unit acknowledges that this is a stage of life when there are a lot of needs to address in order to support patients and families through this process," said Stephanie Harman, MD, founding medical director of the Palliative Care Service. "Stanford as an institution has taken this step to recognize that this is a crucial aspect of care and stage in a person's life." Calling in hospice does not signal a failure of the system, she said, "But rather, an opportunity to improve the quality of care for patients throughout the continuum of their life."

Hospice is a subset of palliative medicine that provides quality of life care for patients with a life expectancy of less than six months. The hospice unit cares for patients who cannot be seamlessly transferred to home without incurring a big detriment to their quality of life and a big spike in their suffering. It was designed to care for patients who cannot achieve the maximum quality of life possible for them without some inpatient intervention.

"Hospice is about making every day the best it can be," said Torrey Simons, MD, a palliative care physician and medical lead for the new unit. "You can't have a good day if your pain and other symptoms like shortness of breath are not controlled."

To support this new unit, Stanford increased staffing of its Palliative Care Service, which is the primary admitting service for this specialized group of patients. Representatives from Pathways see patients on the unit every day with the palliative care service, and provide additional chaplaincy, social work, case management and bereavement support services, beyond what the hospital can provide. Pathways also offers bereavement services to the family for up to 12 months after the death of their loved one.

"We could take care of these patients without Pathways," said Simons. "But we'll do a better job with Pathways." Pathways also helps facilitate the transition to a community-based hospice or to home for patients who become stable enough to move. "The Pathways staff makes sure that the inpatient plan can be seamlessly transitioned to an outpatient plan that will be just as robust and will work at home," said Simons, a clinical assistant professor in General Medicine.

The partnership gives patients the best of both worlds: the additional support from hospice social services, and the inpatient acuity of physicians and nurses who can provide round the clock, advanced care. "Hopefully we're giving them everything they need, which they weren't going to get as an inpatient or a home hospice patient," said Simons.

SHC created the unit in April to improve its ability to care for these patients. "In the past, we were taking care of a number of patients throughout the hospital whose care was focused on their comfort, but doing so in a piecemeal fashion, on a lot of different units," said Harman, clinical associate professor, General Medicine. "This was an opportunity to enhance the care for these patients by co-locating them and doing extensive specialized training with the staff caring for them."

The unit has been operating in a pilot phase for the past two months, caring for one to two patients at a time. But it will grow to four to six beds at full capacity. To refer a patient to the new inpatient hospice unit, call the Palliative Medicine Consult service at pager 26254.