Fulfilling last wishes: improving the compassionate discharge process.

Area of Science:

• Palliative Care
• Quality Improvement
• Healthcare Management

Background:

• Compassionate discharges (ComD), or rapid discharges, are urgent transfers for critically ill patients to die at home.
• Significant challenges exist in timely ComD due to poor process awareness and coordination among stakeholders.
• Delays in ComD are common, impacting patient and family experience during end-of-life care.

Purpose of the Study:

• To reduce family caregiver anxiety and delays in the compassionate discharge process.
• To pilot a Quality Improvement (QI) initiative to enhance the ComD process.
• To maintain a ComD success rate above 90% over a 12-month period.

Main Methods:

• Process mapping, Ishikawa diagrams, and Pareto charts identified barriers like equipment acquisition and communication gaps.
• A Quality Improvement (QI) team developed and piloted a ComD resource package, including checklists, kits, and caregiver resources.
• Three Plan-Do-Study-Act (PDSA) cycles were employed to iteratively refine the resource package based on user feedback.

Main Results:

• The ComD success rate increased across three PDSA cycles, reaching 96.7% after the final cycle.
• A consistent reduction in family caregiver anxiety was observed after implementing caregiver training and resources.
• Failed compassionate discharges were primarily due to acute clinical deterioration or delays in obtaining essential home support, such as oxygen.

Conclusions:

• The developed ComD resource package facilitated interdisciplinary collaboration, improving the safety and effectiveness of compassionate discharges.
• The initiative enabled more patients to achieve their wish of dying at their preferred place of choice.
• The identified QI problem and solutions are applicable across various healthcare settings, highlighting the universal relevance of improving end-of-life discharge processes.