Editor’s note: The DSRIP Difference is a new regular feature in Scoop, highlighting the progress being made through the UTHealth DSRIP (Delivery System Reform Incentive Payment) Projects, which are part of the Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver.
The UT Palliative Care team was consulted to participate in the care of a 69-year-old woman who was admitted to the ICU for difficulty breathing.
Casey Vasta, physician assistant for the Palliative Care program, was charged with helping establish the patient’s goals for her care in an advanced, and ultimately, terminal neuromuscular disease. The patient was an incredibly calm, yet proud, woman who had been managing well with her disease for years. She had watched her father and brother suffer from the illness and eventually succumb to it.
Initially, the patient improved enough to transfer to the routine medical floor, but later her respiratory status declined, necessitating a transfer back to the ICU. She could no longer safely swallow and there were concerns for pneumonia. After receiving this update, the patient agreed to continue with all necessary medical management, including a feeding tube.
The next morning Vasta was called by the ICU nurse manager requesting she come to the patient’s room urgently. He informed her that the patient was tremendously upset, telling the staff she would only speak with Vasta.
Vasta found the patient to be significantly short of breath and declaring through frustrated tears that she had decided to stop everything and wanted to return home immediately. Hospice was not an option because the amount of oxygen she required. Vasta explained the dilemma. The patient gathered her strength and said, “I want to die in the comfort of my home. I know what will happen when I leave here, and I don’t care. Please just get me home.”
Vasta was then faced with the complex task of getting the patient home while preventing her suffering. She was able to rely on the support of the Palliative Care team, which includes a licensed palliative counselor and board-certified chaplain. Together, they were able to arrange for an urgent ambulance transfer to the patient’s home, ensured that a hospice nurse would be waiting for the patient when she arrived to provide continuous end-of-life care, and coordinated the delivery of essential pharmacy supplies. After giving the patient the news that she’d be going home in a few hours, her eyes filled with peace and joy and she smiled in laughter. The patient was transferred home successfully and died peacefully two days later, surrounded by her husband and children.
One of the UT DSRIP projects is to increase access to palliative care services. Through the DSRIP program, UT Physicians has been able to increase funding for palliative care providers and staff to ensure that more providers are trained in palliative care and to provide this important service to more patients.