Palliative Medicine Fellowship Program offers a multi-institutional training
experience, each site offering services to serve the needs of unique patient populations.
Fellowship Training sites:
- Harborview Medical Center
- Seattle Childrens
- SCCA Supportive and Palliative Care Clinic
- University of Washington Medical Center
- VAPuget Sound Health Care Services
PCCS – Palliative Care Consultation Service
The HMC PCCS sees patients referred from the inpatient services. The PCCS team helps the patient, family and care team with goal setting and care directives as well as assess patient appropriateness for and interest in hospice care. The team also advises the primary care team on symptom management and care planning, provides information and emotional support to patients and families, and facilitates discharge planning to community hospice agencies or long term care settings. The team follows patients from initial referral until death or discharge to community-based services. Core PCCS team members include a team leader Dr. Wayne McCormick and other faculty, social worker, chaplain, and trainees, working closely with the pertinent inpatient team. Other services such as pharmacy, interventional pain service, psychiatry, speech therapy, PT & OT are available as needed.
HMC Palliative Care Clinic
New patients get long appointments to allow staff to perform assessments. Nurses will also do lab draws, wound care, I&O catheterizations, IV starts with hydration, EKGs, medication treatments, and injections.
There is a attending assigned to the clinic every day. The attending will personally see each patient and write a chart note if billed at a level three, four or five. The attending must co-sign the billing forms. Fellows must enter into ORCA all clinic notes, as well as review and sign all notes.
The clinic dietician, and social worker, are available for immediate consultation.
The clinic nurse manager fields patient phone calls, assists with medication management, and follows up on lab results needing urgent attention. The CNM schedules patients for appointments and triages questions/care issues to the appropriate provider. Pharmacists are present during all clinic times to counsel patients, refill meds and help with medication issues. They follow-up on drug levels and adjust medication doses if alerted to this issue. They also function as the anticoagulation clinic.
Seattle Children’s is a major referral center for the 5 state region of WWAMI (Washignton, Wyoming, Alaska, Montana, and Idaho). The Pediatric Advanced Care Team (PACT) is the Palliative Care Team at Seattle Children’s Hospital. During this rotation on the PAC Team, fellows will work with a transdisciplinary team of palliative care providers. Our team includes rotating Attending Physicians, a Nurse Practitioner, Consultants, a Program Coordinator, and a Team Manager. Consultants are transdisciplinary team members (with backgrounds in nursing, social work, or spiritual care) who provide continuity, support and advocacy to patients and families that our team serves. During rotations with our team, fellows have the opportunity to learn from both consultants and providers serving patients and families. New consult visits with our team often include a consultant, provider, and a learner. Fellows are able to partner with consultants to help provide ongoing continuity. Our team focuses on a narrative communication approach to consultations. We will work with fellows from all backgrounds on the challenges of being present to pediatric illness and parental grief.
The outpatient Palliative Care clinic at SCCA (Seattle Cancer Care Alliance) is a consultation service. SCCA, Fred Hutchinson Cancer Research Center (FHCRC), University of Washington Medicine, and Seattle Children’s form the only NCI-designated comprehensive cancer center in Washington State. SCCA’s purpose is to provide state-of-the-art, patient and family centered care; support the conduct of cancer clinical research and education; enhance access to improved cancer interventions; and advance the standard of cancer care regionally and beyond.
Our service consists of a medical and administrative director, program coordinator, 3 nurse practitioners, 2 nurses, chaplains, social workers, child-life specialist, nutritionist, and other representatives of SCCA supportive services. Any clinician can refer patients to our service. Patients can also self-refer. The vast majority of our referrals are for pain and symptom management. Fellows are assigned to a 2-3 month long rotation through our clinic (Tuesday afternoon every week). Preceptors are ACHPN-certified ARNPs. New patients are seen for 60 minutes, return patients for 45 minutes.
For more information about the Seattle Cancer Care Alliance, please visit http://www.seattlecca.org/
The UWMC PCCS sees patients referred from the inpatient services, helps the patient, family and care team with goal setting and care directives, assesses patient appropriateness for and interest in hospice care, advises the primary care team on symptom management and care planning, provides information and emotional support to patients and families, and facilitates discharge planning to community hospices and other agencies.
The PCCS team follows patients from initial referral until death or discharge to community-based services. Core PCCS team members include Dr. Stuart Farber, social worker, chaplain, and trainees; medical students, residents, fellows, working closely with primary providers. Other services such as pharmacy, pain service, psychiatry, speech, physical and occupational therapy are available as needed. Patients may be seen in outpatient clinics as well in consultation. The PCCS team meets bi-weekly to review service goals and particular patients.
The VA Puget Sound Health Care System Palliative Care and Hospice Service (PCHS), in existence since 2001, provides a full range of consultative services addressing the patient’s physical, psychological, social, and spiritual needs. The PCHS advises the primary care team on symptom management, goal setting, discussion of code status, communication issues, decision-making, management of spiritual and existential distress, disposition issues, management of psychosocial issues, and care in the last hours of life.
The PCHS provides information and emotional support to patients and their families, assesses patients’ appropriateness for and interest in hospice care, and facilitates discharge planning and referrals to community hospice programs. Additionally, team members communicate regularly with community hospices as case managers for hospice patients receiving home care. Consultative support is provided for veterans receiving inpatient end of life care in the Community Living Center (CLC) 10 hospice beds. The PCHS team includes physicians Dr. David Gruenewald, Dr. Elizabeth Vig, Dr. Robert Pearlman, palliative care and hospice nurses, palliative and hospice care coordinator, CLC nurse practitioner, social workers, psychologist, chaplain, and administrative support personnel.
Other professionals including pharmacists, psychiatrists, dietitians, physical therapists, occupational and recreation therapists are available by consultation. The PCHS team meets weekly in Inter-Disciplinary Team format to review all active patients on the service, as well as to debrief regarding patients recently deceased patients.