Is It an Emergency? Or Is It Hospice?

What are best practices for terminally ill patients who frequent your emergency department? What do patients, families, hospitals and payers want? What is your role? What is the role of hospice?
The Hospital Readmissions Reduction Program was developed for a reason. Consider this: a third of Medicare patients readmit within 90 days; 1 in 5 Medicare patients readmits within 30 days. During the last month of life, about half of patients are in the ED, and almost 10% are there on their last day.
At VITAS Healthcare, we can admit hospice-eligible patients directly from the ED, even when they are symptomatic.
Partner with VITAS to Achieve Key Goals
When your hospital partners with VITAS, patients with end-of-life needs get the right care. Your hospital achieves key goals:

Reduced ED overcrowding, readmissions and observation periods
Improved ED throughput and bed cycling
Seamless transitions to post-acute care
Improved patient/family-satisfaction metrics

Hospitals are penalized for suboptimal ED core measure outcomes, reduced patient/family satisfaction scores, and readmissions of seriously ill patients who may not want to be hospitalized. When surveyed, patients report their preferences to include:

Optimal pain/symptom control
Strengthening their relationships with family
Decreasing their care-burden on family
Prolonging the dying process
Autonomy and maintaining a sense of control
Dying at home surrounded by loved ones

Yet readmissions are often due to unmet discharge planning needs, post discharge care coordination, or insufficient outpatient or community-based follow-up, particularly when coupled with severe progressive illness.
Readmitted patients tend to be elderly with multiple comorbidities that contribute to their decline. Often they have not adhered to follow-up plans, and may not be able to state their diagnosis or explain their medications. Many of these patients are hospice eligible, and identification can fit into a busy clinicians assessment and facilitate optimal disposition decisions.
Signs That a Patient Might Be Hospice-Eligible

Frequent visits to the ED, hospital or ICU
Ongoing symptoms despite optimal treatment
Declining functional status
Development of delirium
Declining renal function
Use of inotropes
Patients goals are for quality of life
Answering No to the question: Would you be surprised if this patient died in the next 612 months?

When referred to hospice as soon as they are eligible, patients receive medical and psychosocial care to control their symptoms and improve quality of life. Care is brought to them where they live by an interdisciplinary team. Continuous care is provided at home when medically necessary, keeping the patient out of the hospital.
Submitted and Written By: VITAS