An Explicit Live Discharge Protocol for Hospice-Initiated Live Discharges

Hospice-initiated discharges, or those not requested by patients or caregivers, are distinct from voluntary disenrollment from hospice because they often occur without adequate preparation. Hospice patients who have stabilized and been deemed no longer terminal can disrupt continuity of care, leaving patients and their caregivers unprepared for the complex medical, emotional, and logistical needs posthospice. Currently, no standardized guidelines exist to support hospice clinicians in planning for and conducting these live discharges. To address this gap, an explicit live discharge protocol (LDP) was developed to guide hospice clinicians in supporting patients who are no longer eligible to receive hospice and are discharged alive and their caregivers. The LDP is intended to support continuity of care by providing hospice clinicians a clear, evidence-informed framework for collecting information and communicating needs before the discharge. This paper outlines the development, structure, and intended use of the LDP as a tool to facilitate compassionate, coordinated, and continuous care transitions out of hospice care.