Consultation Services
Consultation is a type of service where opinion or advice regarding evaluation and/or
management of a specific problem is requested by another healthcare provider, eg,
physician, nurse, social worker, chaplain, etc. A consultant may initiate diagnostic
and/or therapeutic services. The request, and the reason for consultation,
must be documented in the medical record.
The opinion, and any investigations or services ordered or performed must also be documented.
The consultant sees the patient and provides advice to the managing physician or
managing service. The consultant team only participates in the management of the
care of the patient at the request of the attending physician or managing service.
Successful consultants follow good consultation etiquette.
Palliative care consultation services offer specialist assessment and management to
meet patient needs throughout the institution. The consultation team acts on the
premise that primary palliative care is provided to patients and families by the
primary care service. The consultation team provides secondary or tertiary expertise
when needs exceed the expertise of the primary team. Some of the most frequent reasons
palliative care consultations are requested are:
- Pain and symptom control
- Discharge planning and continuity of care
- End-of-life decision making
- Psycholosocial issues involving patients and families
- Ethical issues
Currently, palliative care consultation services have variable composition. In some places, there is only a
physician, or only a nurse. In other places a social worker, chaplain, or psychologist
provides the consultation.
In increasing numbers of settings, palliative care consultation services are
interdisciplinary. Many would
argue that, to be maximally effective, palliative care teams must be interdisciplinary, either as a
routine, or through the process of liaisons with other disciplines maintained by the palliative
care consultant.
Some teams have a dedicated physician and nurse. Others have physician, nurse and social
worker. A few have physician, nurse, social worker and chaplain.
Palliative care services have an important educational role for the attending
physician, managing service, and other health professionals caring for the patient.
CAPC Resources:
Additional resources on "Organizational Models for Palliative Care"
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Elements
Select section:
Basis, Context, Components,
Case Examples
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Basis of Palliative Care Practice
Palliative Care Definitions
Historical Definitions
WHO
Oxford Textbook
ABHPM
NHPCO
Palliative Care
Applicability
Application to Patients at Risk
Differences–Hospice & Palliative Care
Values, Ethical Principles
Values
Ethical Principles
Conceptual Framework
Square of Care
Square of Organization
Square of Care & Organization
Norms / Standards of Practice
Guidelines
Policies, Procedures
What are They?
Developing, Implementing, Evaluating
Measures
Definitions of Common Terms
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Context
Tensions
In Therapeutic Relationships
Within Host Organizations
Within Healthcare System, Community
Who's the Customer
US Healthcare
Acute Care Hospitals
Long-term Care Facilities
Home
Hospice Care
Financing US Healthcare
Expenditures for EOL Care
Overview by Settings, Revenue Sources
Medicare
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing
Community Hospitals
Academic Hospitals
Subacute, Skilled Care
Custodial Care
Ambulatory Care
Home Care
Hospice Care
Eligibility
Covered Services
Reimbursement Rates
Unintended Consequences
Financing Physicians
Coding
Procedure / Service Codes
Coding Based on Time
Frequently Used E/M Codes
Example
Addition of Procedure Codes
Diagnosis Codes
ICD-9 Codes for Palliative Care
Avoiding Concurrent Billing Problems
Example
Documentation
Example
Physician Reimbursement
Medicare
Medicare Hospice Benefit
Non-hospice Physicians
Associated with a Hospice
Medicaid
Commercial Insurers
Managed Care
Government (VA, Military)
Financing Non-physician Providers
Hospital–Hospice Relationships
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Program Components
1º, 2º, 3º Model of Palliative Care Delivery
Interdisciplinary Care
Members of Interdisciplinary Team
Core Competencies
Physician
Nurse
Social Worker
Chaplain
Volunteer
Specialized Environments
Types of Services
Consultation Services
Consultation Etiquette
Consultation Documentation
Sample Note
Inpatient Units
Developing an Inpatient Unit
Staffing
Acuity
Nursing Model
Unit Size
General Ward vs. Palliative Care Unit
Roles
Decisions
Case Example
Nursing Staff
Physician Staff
Other Staff
Advice
Home Care
Eligibility, Medicare Home Health Benefit
Covered Services
Usually Not Covered
Hospice Care at Home
Ambulatory Outpatient Care
Respite Care
Financing Palliative Care Programs
Acute Hospital
Skilled Care Nursing Home
Hospice
Home Health
Ambulatory Outpatient
Managed Care
Financing Physicians in Palliative Care
Financing Non-physicians in Palliative Care
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Case Examples
CAPCManual Case Examples
Pioneer Program Case Examples
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