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Palliative Care and Heart Failure Team Partnership Flourishes

A little more than a year ago, MedStar Washington Hospital Center’s Palliative Care team began partnering with the Advanced Heart Failure (AHF) team at MedStar Heart & Vascular Institute. The Palliative Care team supports AHF patients and their families, helping determine goals for care and ways to manage symptoms and implement comfort measures.

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George Ruiz, MD

Now, as the teams’ relationship has evolved, palliative specialists are brought into the process of developing care plans from the outset—for example, when a patient is being considered for ventricular assist device (VAD) therapy. According to George Ruiz, MD, chief of Cardiology at MedStar Union Memorial Hospital and MedStar Good Samaritan Hospital, the partnership is flourishing. “Palliative Care is also well established at Union Memorial and is developing a strong relationship with the emerging Heart Failure team there,” says Dr. Ruiz.

“When disciplines intersect, you exponentially grow the possibilities and gain a wider perspective,” says Dr. Ruiz. “That’s transformative when we’re making complex decisions about viable alternatives for therapy and what our patients need and want.”

Fully integrating the Palliative Care team into the care of patients with chronic conditions and end-of-life planning is extremely rare, says Hunter Groninger, MD, director of the section of Palliative Care at MedStar Washington Hospital Center. “I do think we’re at the forefront, but as the benefits of palliative medicine become clearer, this model is gaining ground,” Dr. Groninger explains. “Not only are we changing culture but we’re changing the actual process of talking about whole-person care.”

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Hunter Groninger, MD

The teams also are working together on outreach efforts. Last spring, they hosted a summit for clinical leaders of hospice organizations, and another is scheduled in late May for this year. “We want to share what we’re learning from our collaboration as patients move beyond hospital care,” explains Dr. Groninger. “For example, some ongoing treatments currently prevent people from getting into hospice, and we’d like to begin a conversation about how they might be managed.”

Members of the Palliative Care team include palliative care specialist Brian Murphy, MD; nurse practitioner Joan Panke, NP; social workers Anne Kelemen, LICSW, and Regina Tosca; palliative care-trained pharmacist Renée Holder, PharmD; and chaplain Linda Fischer. In addition, Evan DeRenzo, PhD, interim director, Center for Ethics, collaborates with the team.

Dr. Ruiz adds that the teams are grateful for the support from physician leadership: Gregory Argyros, MD, senior vice president, Medical Affairs, and chief medical officer at the Hospital Center; and Stephen Evans, MD, executive vice president, Medical Affairs, and chief medical officer, MedStar Health. “They had the vision; we just made it work,” Dr. Ruiz explains.

Next steps include developing systems so other disciplines in MedStar can replicate the teams’ successful partnership, says Dr. Ruiz. “Working together has opened our thought processes as we assess risks and benefits and learn more about each patient’s goals,” he explains. Says Dr. Groninger, “We’ve worked hard to get here in a year. If our experience can prove to be a model for newer integrated services, that would be a real win.”