General Inpatient Hospice care provides hospitalized patients and their families additional support at the end-of-life. But, a lack of explicit criteria delineating when a hospice referral should be considered results in qualified patients not receiving beneficial services. Additionally, patients that die on inpatient hospice status are exempt from mortality index calculations. This session describes a process for better defining patients for which a hospice referral should be initiated, along with the steps that can be taken to partner with local hospice service providers. These initiatives can improve access to hospice services for hospitalized patients while simultaneously improving key quality metrics.
Problem: Efforts to expand our General Inpatient Hospice (GIP) program have not resulted in an increased number of patients receiving this service and as a result, there are missed opportunities for end-of-life symptom management and family support. There were minimal data to inform improvement efforts going forward.
Measurement: A multidisciplinary team performed 100% mortality case review (n=552) to determine whether a hospice referral was indicated for each case, and if so, whether it was initiated. A Pareto chart was used to visually represent the findings. We also evaluated the time under hospice care prior to death.
Analysis:For patients that did not transition to hospice care, cases were further categorized as: 1) ineligible for hospice, 2) hospice referral indicated but not done, 3) family declined hospice services, or 4) hospice referral initiated, but patient died before completing the transition. These last three are opportunities for improvement.
Implementation: It was observed that the hospital lacked explicit criteria delineating when it may be appropriate to refer patients for hospice care. Following this, we outlined general criteria for patient eligibility for hospice care, along with specific admission indicators suggestive of imminent mortality, warranting consideration for hospice intervention.
Results/Discussion: Fifteen percent of eligible patients were successfully placed into hospice. Of those eligible, but not receiving hospice services, 43% lacked referrals, 4.3% declined services, and 5.5% died before the hospice transition was completed. Next steps include identifying referral barriers and providing specific feedback and education based on these data.
