Emergency department discharges directly to hospice: Longitudinal assessment of a streamlined referral program.

Autor: Markwalter DW; Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, 170 Manning Drive, CB# 7594, Chapel Hill, NC 27599-7594, USA; UNC Palliative Care and Hospice Program, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27514, USA. Electronic address: daniel.markwalter@unchealth.unc.edu., Lowe J; UNC Palliative Care and Hospice Program, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27514, USA; Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 125 MacNider Hall, CB# 7005, Chapel Hill, NC 27599-7005, USA. Electronic address: jared.lowe@unchealth.unc.edu., Ding M; Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, 170 Manning Drive, CB# 7594, Chapel Hill, NC 27599-7594, USA. Electronic address: mingding@email.unc.edu., Lyman M; Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705-3875, USA. Electronic address: michelle.lyman2@va.gov., Lavin K; UNC Palliative Care and Hospice Program, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27514, USA; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27514, USA. Electronic address: kyle_lavin@med.unc.edu.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2024 Dec; Vol. 86, pp. 56-61. Date of Electronic Publication: 2024 Sep 20.
DOI: 10.1016/j.ajem.2024.09.049
Abstrakt: Introduction: 80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice.
Methods: We implemented a QI program in September 2021 consisting of three components: (1) clarification and streamlining of referral workflows, (2) staff/provider education on hospice and workflows, and (3) electronic medical record (EMR) tools to facilitate hospice transitions. The primary outcome was the change in monthly ED-to-hospice cases pre- and post-implementation. We also calculated the monthly incidence rate of ED-to-hospice transfers. The secondary outcome was ED length of stay (LOS).
Results: 202 patients completed ED-to-hospice transfers from January 1, 2019 to February 29, 2024. 98 patients transitioned from the ED to hospice before QI implementation, and 104 patients transitioned after implementation. We observed a slight but insignificant increase in the mean monthly ED-to-hospice cases from 3.16 patients per month pre-implementation to 3.47 patients per month post-implementation (P = 0.46). We found no significant difference in the monthly incidence rate of ED-to-hospice cases before and after implementation (P = 0.78). ED LOS was unaffected (P = 0.21).
Conclusion: In this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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