Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Beth Israel Medical Center
Department of Pain Medicine and Palliative Care
Russell K. Portenoy, MD, Chairman
First Avenue at 16^th Street, 12 Baird Hall
New York, NY 10003

In 1997, the Department of Pain Medicine and Palliative Care (DPMPC) became the first department of its kind at an academic medical center in the United States. The DPMPC provides patient care and services through three divisions: the Palliative Care division, which includes the Jacob Perlow Hospice; the Pain division; and the Acute Pain division. Clinical services are complemented by a broad range of educational and research initiatives run by the staff of the Institute for Education and Research in Palliative Care.

The DPMPC is the first program to integrate pain, palliative care and an established inpatient hospice. The pain and palliative care inpatient unit serves both patients suffering from severe pain but who do not have a life-threatening condition, side by side with patients who are imminently dying. The department's unique palliative care model combines the broad range of services traditionally offered only through hospice, including exceptional pain and symptom management. The DPMPC's comprehensive services include inpatient consultations throughout the hospital, ambulatory case management, access to inpatient services, and specialized programs in fatigue, AIDS pain and symptom control, cancer pain and palliative care, and sexual dysfunction due to chronic illness. The DPMPC's multidisciplinary staff offers a full array of interventions to help the patient and family maintain a high quality of life while living with a serious illness.

As a department, staff members have been able to offer specialized service to a greater number of patients as well as providing a higher profile for palliative care consultation services across the hospital. DPMPC staff has created a wide array of tools to improve palliative care: The Palliative Care for Advanced Disease pathway (PCAD), spotlighted in this issue's Featured Innovation: Part II, serves to establish a standard of care for clinicians engaged in end-of-life care. The PCAD is a quality improvement tool, which allows staff to measure, document and then improve services. The PCAD and other tools and resources, including a substantive section for family caregivers, are available at the department's website at http://www.stoppain.org

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