Department of
Internal Medicine at Highland Hospital
A member of Alameda Health System

Palliative Program

Palliative Care at ACMC

ACMC, located in the most culturally diverse city in the US, is a unique health care facility with a dual mission of providing a comprehensive spectrum of care to an indigent population and maintaining excellence in training physicians and nurses. Thus the opportunities for providing and teaching palliative care in our Medical Center are as rich as the challenges are enormous.

The Palliative Care Consult Service (PCCS)

The PCCS began as a hybrid of the Department of Medicine’s Consult Service and the Medical Center’s End of Life Care Committee. Now the Division of Geriatrics and Palliative Care performs the clinical, academic and administrative duties necessary to maintain and build the program. The goal of the consults: providing primary teams with expert assistance in symptom management, shared decision making guidance and comprehensive psychosocial support to their patients and their families.

Who Are Our Patients?

Many are frail elders or chronically ill patients whose ICU course was unsuccessful at reversing the patients declining health status. Some are imminently dying while others have intractable symptoms best managed in inpatient settings. Many face complicated decisions not optimally addressed by their busy primary team.

Because our patients and their families come from diverse ethnic and racial backgrounds, they face unique challenges to receiving effective and appropriate care. These include navigating the often overwhelming experience of a large country hospital and encountering barriers in communicating their distress to staff who may be unable to understand them; all in addition to coping with their advancing illness.  These are the hospitalized patients most in need of palliative care.

Educational Initiatives

We are involved in the daily training of house staff in the Departments of Medicine and Primary Care who rotate through the Medicine Geriatric and Palliative Care consult service, as well as those Medical and Surgical residents who call us for a consult. In addition, each Primary Care intern spends one month rotating with us on a weekly basis which also includes a home hospice experience.

Since 2009 we have had a physician’s assistant working with the PCCS and with ACMC’s Rapid Response team. She provides didactic training as well as bedside mentoring inassessment skills, symptom management and culturally sensitive communication and decision making to the RRT, floor nurses and house staff.

Each year, we provide 5 palliative care oriented grand rounds, 10 noon conferences to the Department of Internal Medicine and 8 hours of seminars to the Primary Care division . We also create faculty training for ICU, Surgical and Medicine attending staff through faculty development and CME seminars.

The End of Life Care Committee is a monthly interdisciplinary forum of clinical and institutional palliative care champions. We discuss challenging cases, create palliative care policy and provide education for all three campuses of the Medical Center. We always welcome house staff participation on our committee.