Promoting Excellence : Large Inner-City Hospital Serving A Disadvantaged Urban Population

University of Medicine and Dentistry of
New Jersey–University Hospital
New Jersey Medical School
Newark, New Jersey

Patricia Murphy, PhD, APN, FAAN

Patricia Murphy APN Patricia Murphy heads the University of Medicine and Dentistry of New Jersey–University Hospital’s (UMDNJ) interdisciplinary End-of-Life Consultation Service. Murphy started the service in 1999. Prior to coming to UMDNJ, she worked at Beth Israel Medical Center in Newark, where she chaired the ethics committee.

Other members of the End-of-Life Consultation Service include a Baptist minister, two master’s prepared death and dying counselors and an ethicist. A surgeon and an oncologist participate on an as-needed basis. Murphy sees patients and their families every day concerning pain, grief and ethical questions.

The End-of-Life Consultation Service is unlike many hospital palliative care services in that it embraces a broad range of services from middle-of- the-night acute bereavement support to complex ethics consultations regarding treatment decisions for patients who may have no burdensome symptoms. Murphy, who is EPEC trained (Education for Physicians on End-of-Life Care), is a salaried employee of the hospital. Clinical services provided by the End-of-Life Consultation Service are billed to third-party payers.

Palliation for Trauma Victims
The consultation service received a jump-start from a series of grants that permitted Murphy to hire staff. Later, Murphy and Ann Mosenthal, MD, a trauma surgeon, were awarded a joint Project on Death in America faculty scholar grant. Their project was to identify trauma patients who were actively dying and provide them with palliative care. Their success was startling. Word spread within the hospital and soon nurses, physicians and patients’ families began to ask for the End-of- Life Consultation Service. “People started calling when they could see that we were making a difference,” Murphy says.

Working with the Palliative Care and Pain Service at Beth Israel Medical Center, Murphy and Mosenthal developed standing orders for actively dying patients. University Hospital’s Trauma Service incorporated the orders, and they are now accepted hospital-wide for all dying patients. In addition, Murphy regularly conducts pain and ICU rounds. “As residents rotate through the End-of-Life Consultation Service,” Murphy notes, “they learn that there is a better way to care for patients near the end of life and their families.”

Because the program has been developed with grant support, sustaining the team and its clinical services will be a challenge. In an inner-city hospital serving a large population of impoverished patients, the cost savings resulting from the team’s interventions should more than pay for the program’s costs. Murphy is collecting the data to prove this hypothesis. So far, anecdotal evidence indicates that the program is getting people out of the ICU more quickly, is resulting in the use of fewer resources and is decreasing the number of patients in nursing homes in a vegetative state.

Murphy believes that anyone with sufficient drive, a readiness to work long hours—at least in the beginning—and knowledge of pain management can put together a palliative care team and promote the use of standard order forms. She acknowledges, however, that much of her team’s impact on the system is due to the commitment and tenacity of her colleagues.

Personal Reflection
“Many of the patients at our hospital are medically underserved,” Murphy explains. “For some, our service is their first exposure to palliative care. Many people write to us about the excellent care they or their loved ones received here.”

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

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