New York City-based NYC Health + Hospitals/Bellevue recently launched a new palliative care unit.
Dubbed the Palliative Care Serenity Unit, the project has been years in the making as the hospital system saw more patients dying in the hospital due to a lack of serious illness support, according to Dr. Susan Cohen, palliative care program director at NYC Health + Hospitals/Bellevue.
A driving force behind the palliative care unit’s launch has been rising demand among seriously ill patients entering the hospital at various points in their health trajectories, according to Cohen.
“Many of our patients are underinsured or uninsured,” Cohen told Palliative Care News. “They’re vulnerable patients that might not have a lot of social support for a home hospice situation. For the palliative care unit, [it’s] collaborating with nursing staff, hospital medicine teams and the administrative side to make sure that the right patients end up in those beds.”
The new palliative care unit has four dedicated patient beds. The hospital system originally had plans to launch the Palliative Care Serenity Unit in 2020, but the project halted temporarily during the pandemic due to limited available hospital beds and staffing pressures, Cohen stated.
The unit is operated by the hospital’s palliative care program, which collaborates with nurses across its care continuum on meeting patients’ needs. Established in 1736, NYC Health + Hospitals/Bellevue has 851 patient beds and roughly 6,000 employees. Its palliative care program began in 2006, launching its first clinic in 2010 and growing ever since, Cohen stated.
The palliative program offers inpatient consultation services and has hospital-based units alongside outpatient palliative care clinics. The program also operates a palliative care fellowship program.
“We’re co-managing these patients along with the hospital services and other services, so it’s really a collaborative effort,” Cohen said. “We have really good collaborations with our [intensive care unit (ICU)] and emergency medicine teams, our oncology team and our new neurocritical care unit. With each new expertise there’s collaboration.”
The hospital is part of NYC Health + Hospitals Corp., which has an annual census of more than 1.1 million patients. The health system provides primary, pediatric and palliative care, behavioral health care and emergency, trauma and post-acute services, among others. NYC Health + Hospitals has upwards of 70 locations across New York City’s five boroughs, including primary, specialty and post-acute care centers, nursing homes, trauma centers and a home care agency.
A large gap of care existed among hospitalized patients too sick to be transferred into community- and home-based settings, Cohen said. These patients were more likely than others to endure longer hospital stays during a time of increased demand for care, she added.
Having the palliative care unit available for these patients is a move towards improved clinical capacity and patient bedflow, according to Cohen. Even when the unit is full, the palliative team can help transition patients faster out of the emergency setting and into “scatter beds” throughout the hospital to receive care, she explained.
Among the unit’s aims is to improve timely access to hospice when the need arises, said Cohen. The hospital has seen regulatory pressures around general inpatient (GIP) hospice, which has dampened its ability to transition patients to those services, she explained.
Having a hospital-based palliative care unit can help these patients manage their pain and symptoms while reducing their risk of rehospitalization and emergency care use, according to Cohen.
“We noticed that those with more and more end-of-life conditions were staying here and dying here,” Cohen told Palliative Care News. “We believe part of that was a result of regulatory pressures with hospice and patients needing to be sicker and sicker before they are accepted to inpatient hospice. With stricter GIP level hospice, the window narrowed for when you can send patients. Because of that, patients were dying here before the time they qualified for inpatient hospice because they were too sick to transfer. We recognized that we needed to be able to provide what they needed.”
