It is always exciting when the hard work and dedication of those of us in hospice and palliative care are recognized by people outside of our specialty. Such was the case on March 10, 2004, when a the following headline appeared on the front page of the Wall Street Journal: "Unlikely Way to Cut Hospital Costs: Comfort the Dying." 1 The article reported on a study, published last year, from the Virginia Commonwealth University (VCU) Medical Center, 2 which found that palliative care is humane, caring, and cost-effective.

The figures that VCU reported put into black-and-white what many of us have suspected for years but did not have adequate documentation to state with authority. For example, they found that a 5-day stay for a patient with cancer in the Thomas Palliative Care Unit (PCU) cost $5,312, 57% less than it would cost to care for a similar patient elsewhere in the hospital. Overall, VCU officials estimate that the 11-bed Thomas PCU saved the hospital $1 million in 2002.

The article also describes the process by which the Thomas PCU was envisioned, funded, and created, and clearly it was an uphill battle for all involved. Two men are credited with the original inspiration for the Thomas PCU: Thomas J. Smith, MD, an oncologist, and Patrick J. Coyne, MSN, RN, APRN, BC, a clinical nurse specialist with expertise in palliative care and pain management. Alert readers should recognize Pat's name because he is an active member of HPNA and an author and reviewer for JHPN.

According to the Wall Street Journal, Tom and Pat approached the administration at VCU with the idea for the unit. They were met with a response that I am sure is familiar to many, "Prove that there is a need." Pat undertook a clinical record review and identified patients who could potentially benefit from palliative care services. He found that on a typical day, there were approximately 30 patients in house with an incurable disease and symptoms such as nausea and shortness of breath. The first step was complete: they knew there were patients on an ongoing basis who would benefit from palliative care.

Step two required Tom and Pat to obtain funding for the unit, because even though the administration eventually supported the concept, resources were nonexistent to provide financing. Hard work, determination, and a little bit of luck allowed them to secure an adequate financial base to begin construction of the Thomas PCU in 1999. The unit got its name from a $600,000 endowment from the Thomas Hospice Foundation. Other support came from the Jessie Ball duPont Fund and the National Cancer Institute. The doors of the 11-bed unit opened in May 2000, after an 8-month delay due to Hurricane Floyd. Believe it or not, the hurricane resulted in a flood of the pediatric unit at VCU, which necessitated a temporary move of pediatrics to the unopened and unfinished PCU.

Since its opening, it is clear that the Thomas PCU has been successful in fulfilling its mission to provide high-quality and cost-effective care to its patients. This is documented in financial and statistical terms in the Journal of Palliative Medicine 2 and more anecdotally in the Wall Street Journal. 1 Reading both articles gave me a good picture of the work they do and the patients they serve. Unfortunately, the Wall Street Journal fell short in telling readers who is doing this work, since no mention is made of the palliative care team. Although the efforts of both Dr Tom and Nurse Pat are credited, the only other team members who are mentioned are a chaplain, massage therapist, and a "fluffy white Lhasa apso named High Anxiety." I attribute this oversight as a reporter's error, since the team is prominently identified and acknowledged in the Journal of Palliative Medicine report.

While I found reading these articles very helpful, I know that if I were in a position to try and start a comparable unit, I would need much more detailed information and assistance. If you are in a similar situation, you are in luck. The Center to Advance Palliative Care has identified six Palliative Care Leadership Centers, of which the Thomas PCU is one. This initiative provides site visits, training, and technical assistance to those who want to start or strengthen their own palliative care programs. As I noted, it took 6 years, a fair amount of trial and error, and a bit of luck for the Thomas PCU to become a reality. Fortunately, Tom and Pat and leaders at five other centers throughout the United States are willing to share their experiences-hopefully with the end result of a smoother and faster development process for all involved. To learn more, contact the Center directly at http://www.capc.org or by email: [email protected] or phone: 212-201-2670.

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