When pondering palliative care, most people likely envision older patients dealing with advanced or chronic illnesses, requiring additional support.
Seldom do they imagine a scenario involving an otherwise healthy 25-year-old who, after a severe accident on the way to work, finds himself in a trauma ICU.
“There’s no preparation time for patients or families, there’s no arc of an illness or narrative for that societally,” Dr. Jeff Nelson, a board-certified palliative, hospice and family medicine physician and assistant professor at the University of Tennessee Health Science Center, told Palliative Care News.
Nelson helped Memphis-based Regional One Health’s Trauma ICU launch an inpatient palliative care program in July 2022 to better support those patients and their families, along with more typical palliative care patients.
The hospital houses the region’s only Level 1 Trauma Center. It also boasts the Centers of Excellence in neonatal intensive care, burn and high-risk pregnancy, and a growing Oncology program. Nearly 60% of the hospital’s patients come through the Trauma ICU, according to Nelson.
“It’s a place where there’s a lot of people with both chronic and acute critical illness, severe injury, and there’s just a big need for that kind of extra support that palliative care provides,” Nelson, director of the program, said.
A $1 million grant from the Community Foundation of Greater Memphis’ Mid-South COVID-19 Regional Response Fund made the program feasible. The foundation, comprising 950 donor funds established by individuals, families and organizations, received an $8 million donation in December 2020 from billionaire philanthropist Mackenzie Scott, ultimately enabling the formation of the hospital’s new program.
“A lot of it just felt like the universe coming together,” Nelson said.
He emphasized the unwavering support from Regional One’s administrators, especially Dr. Martin Croce, the hospital’s chief medical officer, who championed the program’s creation and self-sustainability from the start. At Regional One, Nelson operates alongside a program manager, a social worker, two nurse practitioners, and a rotating cadre of medical residents and fellows.
“I feel like I won the lottery in the people that we have enlisted to be part of our team,” Nelson said.
However, recruiting physicians has proved challenging, he said, as those who train in UTHSC’s Hospice and Palliative Medicine Fellowship often opt to start programs elsewhere. Nonetheless, Nelson said Regional One has seen a glut of superb candidates for nurse practitioner and social worker roles, primarily recruiting externally.
Beyond trauma patients, Nelson’s team serves people with malignant hematology and some in the neonatal intensive care unit, the latter being an area the department is expanding. The program also supports traditional palliative care patients.
“With specialized in-patient palliative care, we really get the opportunity to take what can be the worst moments of people’s lives and make them less worse, which is a net positive,” Nelson said.
Billing for these palliative services occurs traditionally through per-visit fees, though Nelson noted the hospital has experienced higher reimbursement levels than anticipated.
In addition to aiding ill or injured patients and their families, Nelson’s team supports hospital staff.
“I think that we’ve become a fairly integral part of the daily hospital milieu and make that part of our mission to just be there for them,” he said.
For example, Nelson said the palliative team conducts daily rounds with the trauma surgery service, debriefing nurses and staff about challenging patient experiences. He also delivers biweekly lectures to the trauma surgery fellows.
Discussing the future, Nelson said he hopes the existing outpatient palliative care clinic embedded in the hospital’s oncology clinic can operate more extensively and expand beyond oncology patients as staff numbers increase.
Moreover, a home-based palliative branch will enable nurse practitioners and social workers to further assist those in need, according to Nelson. He also thinks the team will begin focusing on patients earlier in their disease course.
“When we help people make decisions about their care that is in line with what’s sacred to them in their lives; when we help them navigate difficult symptoms more gracefully and allow them to be more functionally engaged with their families and loved ones — to me, it really is heartwarming and keeps me going,” Nelson said.