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A Hospice Transitions Program for Patients in the Emergency Department.

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A new multidisciplinary program significantly increased hospice use for emergency department patients nearing end of life. This initiative improved hospice transitions and reduced in-hospital mortality, aligning care with patient goals.

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Area of Science:

  • Palliative Care
  • Health Services Research
  • Quality Improvement

Background:

  • Emergency department (ED) visits are common for end-of-life patients, often leading to hospital admission and misaligned care goals.
  • Delayed transition to hospice care can result in inpatient deaths contrary to patient wishes.

Purpose of the Study:

  • To evaluate a novel multidisciplinary program designed to expedite hospice identification and enrollment for patients in the ED near end of life.
  • To assess the program's association with increased hospice utilization.

Main Methods:

  • A pre-post quality improvement study was conducted at an academic medical center.
  • The intervention involved a formalized care transitions pathway with alerts, training, vendor expansion, and data tracking.
  • Data were collected for adult patients presenting to the ED near end of life during control (Sept 2018-Jan 2020) and intervention (Aug 2021-Dec 2022) periods.

Main Results:

  • The intervention group showed a significant increase in hospice transition without hospital admission within 96 hours (54.1% vs 22.6%, P < .001).
  • The program was associated with a higher likelihood of hospice transition (adjusted odds ratio, 5.02).
  • In-hospital mortality decreased in the intervention period (48.5% vs 64.4%, P < .001), with no change in length of stay.

Conclusions:

  • A multidisciplinary program effectively enhanced hospice transitions for emergency department patients.
  • The findings suggest the program's potential to improve end-of-life care alignment and reduce mortality.
  • Further research is warranted to confirm generalizability and long-term sustainability.