Reducing Hospitalization in Adult Hospice Patients by Leveraging End‑of‑Life Conversations: A Quality Improvement...

The purpose of this quality improvement project was to implement advance care planning during end-of-life (EOL) discussions with patients in hospice and to determine the effects on reducing hospitalizations. Aims included (1) increasing the frequency of EOL conversations as part of advance care planning from 18.5% to 40%. (2) Decreasing the percentage of Bronx and Manhattan hospice live discharges due to hospitalization from 11% to 9% within 3 months. A structured EOL conversation model for hospice admissions, combining admission-day discussions with follow-ups within 7 days was implemented to enhance documentation (compliance) and care planning while supporting sustainability through staff training and interdisciplinary collaboration. Data were collected using electronic medical record integrated workflows and analyzed using a binomial test to determine compliance and hospital transfers. Of 24 hospice discharges, only 1 patient was transferred to noncontracted inpatient facility, resulting in a hospitalization rate of 4.25% (P < .001), which represents a 61.8% reduction from the baseline rate of 11%. The implementation of a 2-touchpoint EOL conversation model demonstrated improvement in hospitalization.