Palliative care is becoming increasingly better integrated into the care offering of hospitals, as shown in the new report ‘Palliative care in Dutch hospitals 2023’ from IKNL. This is necessary as the number of complex care needs in the palliative phase is increasing. In this three-yearly survey, IKNL researchers once again surveyed the palliative care teams in Dutch hospitals, with the aim of gaining insight into the development from 2012 to 2023.
The palliative care teams (PZ teams) from 58 Dutch hospitals participated in the study, which is conducted once every three years and this time achieved a response rate of 81%. For the fifth time, the report provides insight into the state of affairs regarding palliative care in hospitals. In view of the expected growth of patients with palliative care needs, integration of palliative care into regular care is necessary. The quality of the mutual cooperation between generalist and specialist palliative care providers plays an important role in this.
Palliative care needs are better identified in hospitals
The results show that palliative care needs are better understood in hospitals. Three-quarters of hospitals routinely screen for palliative care needs in outpatients. In addition, more than half of hospitals (59%) regularly screen for symptoms in outpatients in the palliative phase, with the Utrecht Symptom Diary (USD-4D) being increasingly used. Two-thirds of the PZ teams perform outpatient consultations and approximately half of the PZ teams have an outpatient consultation hour (53%). Research has shown that the availability of an outpatient palliative care consultation hour is associated with more and earlier referrals to the PZ team. It is therefore recommended that hospitals invest in the outpatient accessibility and availability of the PZ team, to increase the number of referrals to the PZ team for patients with complex care needs and to improve the timeliness of these consultations.
Position of PZ teams improved
The results also show that the position of the PZ teams is gradually becoming stronger. In 2023, HR teams will be consulted more and more often and there will be an increase in the number of clinical consultations per HR team. This may indicate a strengthened position within the hospital. Despite this increase, the coverage ratio, the number of clinical consultations of the PZ team as a percentage of the annual number of clinical admissions, remains limited (1.7%). It is possible that patients with complex palliative care needs in the Netherlands are not yet sufficiently seen by the PZ team. Early deployment of the PZ team contributes to better care in the final phase of life and less potentially unwanted (expensive) care. Investments in the capacity, level of training and accessibility of the PR teams through outpatient consultation hours can relieve the pressure on the teams, allowing more appropriate care to be provided in the last months of life.
More complex palliative care needs
The increase in the number of consultations may indicate a more complex healthcare demand, caused by new treatment options and longer survival times for patients with an incurable disease. At the same time, this increase may also indicate that PM teams are being called in more often in situations where general palliative care should actually be sufficient. This may be due to limited knowledge and experience with palliative care of generalist healthcare providers. Improving the expertise of healthcare providers in palliative care could alleviate the pressure on PZ teams, preserving their capacity for patients with more complex care needs. Hospitals are therefore advised, on the one hand, to continue investing in the position of the HR teams, so that they are deployed in a timely manner, and on the other hand, to better train healthcare providers to be able to independently provide basic palliative care. This is crucial given the expected increase in patients with (complex) palliative care needs. There are good training courses available for this.
More transmural cooperation
In addition, an increase in transmural consultations can be seen. This indicates better integration of palliative care into regular care outside the hospital. In more than half of the HR teams (55%), the GP is a permanent part of the team. Three quarters of the PZ teams (76%) work transmurally through the participation of frontline professionals in the MDO of the PZ team. This is a significant increase compared to 2020, in which this was the case for two-thirds of the PZ teams. In addition, HR teams offer telephone consultation to healthcare professionals of patients outside the hospital (64%). A third of the PZ teams are also available for home visits (34%). Hospitals are recommended to promote the transmural transfer and availability of the PZ team for patients at home and their caregivers.
Proactive care planning not yet structurally embedded
For the first time, this survey explicitly asked about proactive care planning. Only one in three hospitals has included proactive care planning as a permanent part of their care policy for patients with palliative care needs. According to the objectives of the Integrated Care Agreement (IZA) on appropriate care in the final phase of life, a discussion should take place with all patients in the palliative phase and their loved ones about treatment wishes, limits and choices. This helps to provide insight into their values, wishes and needs. However, almost half of the HR teams (42%) indicate that no structural discussions about proactive care planning are held within their hospital. Known barriers are the complexity of the subject, limited communication skills and expertise of healthcare providers, and the financing of proactive care planning.
PZ teams play an important role in increasing expertise in this area. Two-thirds of teams (67%) have already included proactive care planning in their continuing education for healthcare providers. To further promote this, hospitals are recommended to structurally invest in the development of expertise of (new) employees, for example through training in palliative care.
There will come a day when the oncologist says, I have no more treatment for the disease. You can now think about questions such as: where and how do you want to spend the last phase of your life? […] In addition, knowing the patient’s wishes and boundaries can provide support to loved ones during a difficult time. There’s enough coming your way when someone gets sick. So make choices while you are still good enough. Jill van Houten, neighbor
Conclusion
The results show that palliative care needs are better understood: three quarters of hospitals routinely screen for palliative care needs in outpatients. The number of consultations by the PM teams has further increased, which may indicate better awareness of the teams within their own hospital, but also an increase in more complex care needs. Other positive developments: more than half of the PZ teams now have outpatient consultation hours and there is more transmural collaboration with primary care.
Yet there is still room for improvement. The transmural transfer can be improved. Nearly half of the HR teams indicate that no structural discussions about proactive care planning are held within their hospital. The report emphasizes the need for an integrated approach in which, on the one hand, the specialist expertise of the PZ teams is strengthened and on the other hand, generalist healthcare providers have enough knowledge to be able to independently provide basic palliative care. This division of labor relieves the pressure on the HR teams, ensuring that their capacity is maintained for patients with more complex care needs. In addition, it remains urgent to involve the HR teams at an early stage so that – through proactive care planning – care in the final phase of life is provided that suits the wishes and needs of patients and that can prevent unwanted (expensive) care.
More information
View the Report here Palliative care in Dutch hospitals 2023
For questions about this report, please contact Nienke van Velzen and Sytske Wiegersma.
Hospitals & Palliative Care: A British Comedy of Errors, oops, I mean, Necessity!
Welcome, dear readers! Today, we’re diving into the intriguing world of palliative care in Dutch hospitals. Yes, palliative care – the delicate art of providing support as patients navigate the last leg of their journey. And trust me, it’s more complicated than putting IKEA furniture together without the manual.
Palliative care is becoming increasingly integrated into the hospital system in the Netherlands, according to the newly released report, ‘Palliative Care in Dutch Hospitals 2023‘ from IKNL. It’s about bloody time! With the number of people needing complex care increasing faster than a cat on a hot tin roof, we’re in urgent need for a stronger care framework.
The Good, The Bad, and The Palliative
Let’s break down this report, shall we? With a staggering 81% response rate from 58 Dutch hospitals, this three-yearly survey offers some eye-opening insights. Firstly, it’s encouraging to see that hospitals are finally grabbing the bull by the horns and screening for palliative care needs like a pro. Three-quarters of those involved now routinely check for palliative care requirements in outpatients. At this rate, we might all be professionals in dying gracefully!
That said, there’s room for improvement. Half of the hospitals are still struggling to screen symptoms effectively in outpatients. It’s almost as if they’re waiting for someone to create a Netflix series about palliative care – because, let’s be honest, that would be riveting, right? “Coming this fall: Keeping Up With the Palliative Care Providers!”
Making Strides, One Consultation at a Time
Interestingly, more than half of the hospitals have created an outpatient consultation hour. How’s that for making lemonade out of lemons? Clinical consultations among HR teams are on the rise, and if the coverage remains limited at just 1.7% of annual clinical admissions, at least it’s a bounce from zero! I guess it’s like trying to get the last slice of pizza; you’ve just got to keep trying, folks!
Complex Needs: The New Norm
Let’s talk about the elephant in the room: complex palliative care needs are on the rise faster than a pop star’s ego after a hit single. With new treatment options and patients surviving longer with incurable diseases, the demand is higher than ever. But, ah, there’s always a but! This also means that PM teams are being pulled into situations where basic palliative care could suffice. So we’ve essentially got specialist doctors doing what generalists should be doing. Can you hear the “who’s to blame” music playing in the background?
Training Day Keeps the PZ Team Away…Or Not
Here’s where it gets deliciously ironic! The hospitals are advised to invest heavily in training for generalist healthcare providers to ensure basic palliative expertise is widespread. Yet the same hospitals struggle to create structural proactive care planning discussions. If I had a penny for every time a hospital said, “We’ll get to that later,” I’d be able to fund my own comedy tour, complete with a palliative care segment.
“There will come a day when the oncologist says, I have no more treatment for the disease. You can now think about questions such as: where and how do you want to spend the last phase of your life?” – Jill van Houten
The (Trans)Mural Picture
Transmural consultations are increasing, meaning palliative care is merging more seamlessly with regular care outside the hospital. Now, that’s what I call a team effort! With half of the HR teams formally involving GPs, it’s about time that healthcare stepped outside the rigid hospital walls and embraced a community-driven approach.
Wrap Up And Recommendations
In conclusion, we see a clear understanding that while hospitals are treading the right path, they still have a long way to go. The report shines a spotlight on the urgent need to bolster both specialist and generalist palliative care knowledge. With proactive care planning still lagging behind, it’s like a slow-motion train wreck waiting to happen! Let’s hope they get on it before it derails.
So, as we bid adieu to the realm of hospital reports and palliative care woes, remember: the key to good care is making those proactive discussions happen. Because as our dear friend Jill pointed out, while the clock is ticking, choices have to be made – and they should be made well before the oncologist delivers the dreaded news.
For more information, check out the full Report on Palliative Care in Dutch Hospitals 2023 and let’s hope they continue to improve – we might just send a comedy special their way one day!
How can hospitals improve communication around treatment wishes and end-of-life care?
Y time a hospital missed a chance to have a proactive care planning discussion, I’d probably have enough for a lavish dinner, complete with a side of irony! You’d think they would get the memo that communication is key, especially when it comes to discussing the delicate topics of treatment wishes and end-of-life care.
A Love-Hate Relationship with Transmural Cooperation
Before we wrap this up, let’s touch on the tantalizing topic of transmural cooperation — which sounds complicated enough to be a dance move at a hospital gala! The good news? There’s been a notable increase in collaboration between hospital teams and primary care providers, with more GPs becoming permanent fixtures in palliative care teams. Gold stars all around! But hold your applause: too many HR teams are still struggling to have regular proactive planning discussions, which doesn’t just throw a wrench in the works — it more resembles casting a banana peel in front of a moving vehicle.
The Final Curtain Call: A Call for Action
So what’s the takeaway, dear readers? While the report shows significant strides in how Dutch hospitals are handling palliative care, the call for improvement rings louder than a fire alarm at a wedding. If we want to avoid unwanted (and expensive) care in the final phase of life, there’s a pressing need to ensure HR teams are engaged early and often. After all, nobody wants a healthcare version of “Oops, we did it again!” at such a crucial juncture.
hospitals must continue their investment into both specialized palliative care teams and generalist training, allowing them to focus on patients with complex needs — and ensuring the likes of proactive care planning become the norm rather than the exception. Because the last thing we need is a comedy of errors at such a tender time in life.
Stay Informed
For more on this riveting topic, be sure to check out the full report titled Palliative Care in Dutch Hospitals 2023. And for any inquiries, you can reach out to Nienke van Velzen and Sytske Wiegersma, who are undoubtedly much more knowledgeable than your humble narrator!