Just-in-Time Interdisciplinary Education for Hospice Care of Ventricular-Assist Device Patients

Ventricular-assist devices (VADs) offer end-stage heart failure patients a chance to live longer and better. VAD patient numbers are growing, as is the need for their hospice care, whether they die from cardiac or noncardiac causes. But many hospices do not accept VAD patients because of unfamiliarity with the technology. In 2017, there were no hospice agencies in our area accepting VAD patients. Mr. S was a 61-year-old man with a VAD implanted in 2011. In 2016, he was diagnosed with metastatic colorectal adenocarcinoma, underwent surgical resection, and suffered many postoperative complications. In January 2017, he was hospitalized for a driveline infection and bacteremia. During that stay, Mr. S opted for comfort care with the goal of returning home. The only chance of Mr. S's going home rested on our hospice agency's accepting him. In less than two weeks, our hospice staff partnered with the patient's VAD team to develop the competencies to care for Mr. S. He was stabilized at our inpatient unit and then spent several weeks at home before symptoms required return to inpatient care. When Mr. S became unresponsive, his family chose to inactivate the VAD; Mr. S's death followed quickly and peacefully. Our agency now routinely provides hospice care for VAD patients. It is increasingly important that hospice agencies accept VAD patients seeking hospice care. By drawing on educational resources available from VAD patients' acute-care hospital-based VAD teams, interdisciplinary education of hospice staff can be accomplished quickly and effectively.