Changing Institutional Culture Around Hospice Using LEAN Tools to Improve Hospice Utilization in a Veteran Population.

Autor: Yamarik RL; Long Beach Veterans Affairs, Long Beach, California USA. Electronic address: rebecca.yamarik@va.gov., Wenziger C; Long Beach Veterans Affairs, Long Beach, California USA; Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California, USA., Streja E; Long Beach Veterans Affairs, Long Beach, California USA; Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California, USA., Pham AN; University of California, Irvine School of Medicine, Irvine, California USA., Wei KS; University of California, Irvine School of Medicine, Irvine, California USA., Bedi B; University of California San Diego School of Medicine, San Diego, California USA., Asch S; Department of Medicine, Stanford University, Stanford, California USA; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2021 Oct; Vol. 62 (4), pp. 836-842. Date of Electronic Publication: 2021 Apr 05.
DOI: 10.1016/j.jpainsymman.2021.03.021
Abstrakt: Background: Longer hospice length of stay improves the palliation of symptoms, quality of life, and the dying process for patients and their caregivers. We used a Lean designed Rapid Improvement Event (RIE) to facilitate earlier entry into hospice.
Measures: Our primary outcome was hospice length of stay. Secondary outcomes were avoiding unwanted inpatient utilization and hospice location.
Interventions: We conducted a five-day RIE utilizing Lean tools targeting the inpatient medicine wards.
Outcomes: Hospice length of stay increased from a median (interquartile range [IQR]) of 11 (7,27) days prior to 37 (7,73) days following the RIE. Home hospice and outside Skilled Nursing Home (SNF) hospice use increased while use of the onsite VA hospice decreased.
Conclusions/lessons Learned: LEAN tools can be used successfully to improve end of life outcomes in an inpatient VA setting. The 90-day sustainment period following the RIE uncovers barriers to implementation and allows for adjustments to implementation.
(Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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