North York General Hospital (NYGH) is a community academic teaching hospital that provides palliative care services through the Freeman Centre for the Advancement of Palliative Care. The Freeman Centre is a patient- and family-centered program that provides an added layer of support to patients with advanced serious illness. The key features of the Freeman Centre are the seamless transition of patients through each care setting and consistent delivery of care by one integrated multi-disciplinary team from referral to end of life.
The Freeman Centre for the Advancement of Palliative care includes three delivery models: inpatient, ambulatory care and home-based care. Our inpatient program offers consultation services and 6 dedicated pain and symptom management beds into which we admit patients from elsewhere in hospital or directly from home, avoiding emergency department visits and reducing hospital costs. Our outpatient clinic enables patients to manage pain and symptoms with the help of the same clinical team from their inpatient stay. The outreach program offers home-based care for patients too ill to leave their homes. Annually, the Freeman Centre serves approximately 1,000 inpatients, 120 clinic and 100 outreach patients. Cancer outpatient clinic volumes have tripled since 2008 and the centre recently expanded the outpatient services to include those with advanced heart failure and respiratory illness.
Congestive Heart Failure (CHF) patient data indicates that the Freeman Centre helped to reduce emergency department visits, hospitalizations and intensive care unit admissions by 16%-24%. Code statuses from this population changed from 29% full code to 11%, 39% Do Not Resuscitate (DNR) to 88%, and 32% not documented/discussed to 1%. A total of 30% of these cardiac patients have died at home or in a Palliative Care Unit.
Patient and family feedback has been exceptionally positive and deeply meaningful. Benefits to NYGH include reduced emergency department and inpatient load, and operating costs: according to the 2014 Auditor General’s report, the average per patient cost for inpatients in the last month of life is $1100/day compared with at-home care costs of $100/day.
Patients living with a diagnosis of an advanced life-limiting illness often have concerns regarding symptom burden, physical and psychosocial impact on life, and questions surrounding end-of-life processes. The Freeman Centre for the Advancement of Palliative Care strives to meet the complex care needs of patients with advanced life-limiting illness through a multidisciplinary approach to care that optimizes the patient and family experience for this vulnerable population.
Title: Program Director, Cancer Care and Ambulatory