The Division provides physician coverage in several clinical programs in different settings across Ottawa and the Champlain LHIN region.
In October 2010, the 36-bed Palliative Care unit at the √Člisabeth Bruy√®re Hospital was restructured and divided into 2 separate units; an acute unit (20 beds) and a sub-acute unit (16 beds).
The 20-bed acute palliative care unit (5th floor of the √Člisabeth Bruy√®re Hospital) admits patients with complex needs that require high-intensity care by a specialist interprofessional palliative care team. Some patients require short stays of only a few days to get their symptoms controlled, at which time they are discharged back to the community or to a residential hospice. Some patients may have life expectancies of days to weeks, while others may still have many months of life remaining but need symptoms controlled in order to improve their quality of life. The unit also occasionally admits patients whose diseases are well controlled with treatments such as chemotherapy or radiotherapy but need hospitalization to control severe symptoms such as pain, nausea or shortness of breath. The unit admits patients with cancer and non-cancer diagnoses such as end-stage heart, lung and neurological diseases. The Division‚Äôs physicians take on the role of the most responsible physicians (MRP) for the patients on the unit. Physicians see patients every day of the week (Monday to Sunday) and are available 7 days a week, 24 hours a day.¬† The unit is a regional resource and admits patients requiring this level of care from across the Champlain region. The interprofessional team consists of nurses (RNs and LPNs), physicians, personal support workers, a social worker (part-time), a pharmacist, a psychologist (part-time), an occupational therapist (part-time), a physiotherapist (part-time), a chaplain (part-time), a recreational therapist (part-time), clerk (part-time) and volunteers.
The 16-bed Bruy√®re Sub-acute palliative care unit (5th floor of the √Člisabeth Bruy√®re Hospital) admits patients requiring end-of-life care (last days and weeks of life) whose needs are less complex than those on the acute palliative care unit.¬† While the Division‚Äôs physicians are the MRPs, by mid 2011, the MRP role will be taken on by family physicians, mainly from the Academic Family Health Team at Bruy√®re Continuing Care (Bruy√®re and Primrose Sites), with the Division‚Äôs physicians providing specialist consult support through the PPSMCS. An interprofessional team (shared with the acute palliative care unit) cares for patients on the unit. Physicians see patients two to three times a week (or every day if required) and are available 24-hours per day, seven days a week.
The PPSMCS is an interprofessional specialist-level palliative care consultation team that provides specialist-level palliative care support to primary health professionals (family physicians, home care case managers and nurses) caring for patients in the community, long-term care facilities and retirement homes. The service is based out of the √Člisabeth Bruy√®re Hospital and is funded by the Ontario Ministry of Health and Long Term Care (MoHLTC). It is a Champlain-wide regional resource and provides consultation and advice to primary health teams across the Champlain LHIN region (Hawkesbury in the east to Chalk River and Pettawawa in the west, and Cornwall and Kemptville in the south). The team consists of 2 palliative care advanced practice nurses (APN) in the Ottawa area, an APN based in Renfrew/Pembroke and covering the western part of the region and another APN covering the eastern part of the region, a nurse practitioner (NP), 1.5FTE physicians from the Division and an administrative assistant. The team‚Äôs mandate is to support and empower primary health professionals in providing palliative care and sees patients in their homes, in longterm care facilities and in retirement homes. The team does not take over the care from the patient‚Äôs family physician and does not provide primary care for those patients who do not have a family physician (other resources are available to take on the primary care of these patients).¬† The service‚Äôs philosophy is to enable and empower as many primary professionals as possible with palliative care skills so as to ensure that as many palliative patients as possible receive good palliative care. Consistent with the vision of the new Champlain Regional Palliative Care Program, the philosophy is that relying only on a small group of specialists palliative care physicians is neither appropriate nor sustainable. ¬†The team is available 24 hours a day, 7 days a week and can be reached through the Bruy√®re switchboard at 613-562 6262.
The TOH is a leading academic health sciences centre in Canada with 3 campuses; the General Campus, The Civic Campus and the Riverside Campus. The General and Civic campuses combined have approximately 1170 beds and are the region‚Äôs largest teaching hospitals. There is a specialist-level palliative care consultation team at each of the two campuses (General and Civic). The teams, made up of Division palliative care physicians and advanced practice nurses as well as two social workers, provide consultation support to colleagues from a variety of specialty areas, including medical and radiation oncology, hematology, internal medicine, hematology, nephrology, cardiology, pulmonology, critical care, emergency care, neurology and family medicine. They make recommendations to the attending teams and do not take over the primary care of patients (i.e. do not take over as most responsible physicians). The teams at the two campuses are available 24 hours, 7-days a week for referrals. The Division‚Äôs physicians rotate through the General and Civic Campuses every few months.
The teams, at each of the two campuses, provide the following consultation support:
Managing chronic pain in patients who do not have progressive incurable illnesses is not within the mandate of the palliative care consult teams. Such patients should be referred to the Complex Pain Clinic.
Supportive and Palliative Care outpatient consultation clinics are held Monday to Friday at the TOH Cancer Centre. Four of these clinics (Monday am & pm, Tuesday am at the Complex Cancer Pain Clinic, and Wednesday pm) include physicians from the Division and a palliative care advanced practice nurse, while the rest of the clinics (Thursday and Friday) are nurse-only clinics. From the Spring 2011, the Division will have a physician GPO (general practitioner in oncology) trained in palliative care available Monday to Friday for consultations and triaging. The clinics provide a consultation service and do not take over the primary care of patients. Referrals are mainly from oncology colleagues. The clinics see patients across the spectrum of cancer care, from patients whose cancer has been cured or is under control but are experiencing symptoms (physical and psychological) that affect quality of life to patients who have progressive incurable disease and have months or weeks to live. Oncologists are encouraged to refer patients to the clinic earlier in their illness trajectories (not just at the end of life) so as to improve their quality of life whether their diseases are progressing or are under control or cured. The clinics provide the following services:
The palliative care teams works closely with the Psychosocial Oncology Program and refers patients with severe psycho-social issues to that program when required. The team also triage patients who may benefit from referral to the Complex Cancer Pain Clinic for neuraxial blocks (such as epidurals and¬† intrathecals, ¬†regional anesthetic blocks, and ketamine and lidocaine infusions). ¬†The Division provides a palliative care physician to work alongside the anesthetists at the Complex Cancer Pain Clinic, which is held on Tuesday mornings at the Pain Clinic at the Critical Care Wing of the General Hospital/Campus.
Supportive and Palliative Care outpatient consultation clinics are held at the Irving Greenberg Cancer Centre on Monday afternoons and Wednesday mornings. A Division physician works alongside a palliative care advanced practice nurse at each of these clinics. Their role is the same as in the outpatient Supportive and Palliative Clinics at the TOH Cancer Centre (see above)
The Hospice at May Court is a 9-bed residential hospice in central Ottawa. It also provides community-based hospice services, including day hospice, hospice-at-home and grief and bereavement services. Patients are admitted to the residential hospice for end-of-life care (last days and weeks). One of the Division‚Äôs physicians serves as medical advisor to the Hospice at May Court. The Bruy√®re PPSMCS palliative consultation service provides specialist-level consultation services at the Hospice.
The Queensway Carleton Hospital has a palliative care consultation team to provide consultative services for in-patients admitted to the various specialty services at the Hospital. This team consists of a Nurse Practitioner (full time) and a palliative care physician from the Division (part-time). After-hours telephone-only consultation is provided by the Bruy√®re PPSMCS consultation service.
The Montfort Hospital is in the process of establishing an in-patient palliative care consultation service with a nurse and palliative care physician. The physician will be provided by the Division (part-time).