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Palliative Care and the ICU

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Post ICU and Hospice
Author: LibbyT
Date: Mar 3, 2010 10:30 am
Hi - I am new to this forum. We have a well-established palliative care service in a large metropolitian hospital in Houston. We are very active in our ICUs and have a proactive palliative care pilot program to reduce death in the ICU underway. We have in-hospital hospice beds available and contract with a local hospice for the care and overall we are quite successful at hospice transition to appropriate settings. Now our administration wants us to set up a program to hospice patients in the ICU setting (i.e. just 'flip the bed' to hospice). Our PC team is opposed to this as is our hospice vendor. I'm interested in perspectives and if anyone is currently doing this.
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- Re:ICU and Hospice (by barton_bobb on 03/23/2010)
Libby, from a financial standpoint, this decision to "flip" an ICU bed to a hospice bed certainly doesn't seem to make sense. (Not to mention the issue of tying up an ICU bed if they need it for another pt requiring ICU level care and ICU nurses having to switch gears 180 degrees that may be difficult for them (beyond terminal wean and comfort/palliative care until transfer to palliative care bed/general med bed for example). Frankly, a LOT of money would likely be lost (based on inpatient hospice reimbursement only (current FY '09 medicare reimbursement rate of $622 per day for inpatient hospice)). Even though some money would probably still be lost, it would make more sense to have a few general medicine floor beds designated as "swing beds" (if that is possible - we are currently evaluating the logistics and costs involved in potentially doing so at our institution.....we did so a while back ago and regulations governing inpatient hospice were prohibitive in achieving this goal). Our primary impetus for trying to create some inpatient hospice swing beds in our institution is the suffering that our patients (and particularly their families) often go through when we are forced to move them from our institution to an inpatient hospice floor at another facility nearby. Hope this helps.
+ Re:Re:ICU and Hospice (by LibbyT on 03/23/2010)
Thanks so much - we don't think it makes any sense either, but wanted to query our partners so we have some back-up as we push back. I appreciate the detailed reply!
How this started was - One of our new execs stated in a meeting that at her former hospital they routinely flipped patients in ICU beds to hospice, and that it was 'the industry standard in the NE'. Some people leapt like a trout to the fly at this. Of course it's not the industry standard anywhere and I discovered was not the practice at that particular hospital. But the leadership is fixated on this and we're trying to very diplomatically avoind starting a new program that doesn't do anything other than impact mortality. We have a great in-hospital hospice program on a deicated medicine unit that we can transfer patients to, so we have that component in place. Thanks again - this will help!
Re:ICU and Hospice (by Deb on 03/23/2010)
I agree that this not make financial sense at all. Our palliative care consult team is very active in the ICU, and frequently meet with pt/families to assist with decisions about withdrawal of support. Once support is withdrawn, if the pt looks like he/she is actively dying, we leave them there. They usually require more intense titration of meds for comfort anyway. But, if they get to a point where they seem pretty stable, ie.. they won't die in the elevator, we move them to our oncology unit which is also our palliative care unit for pts on comfort care. If after 24 hrs, they still seem pretty stable, we call hospice- we have a hospice associated with our healthcare system and they have liasons in-house. Administration wants to see decreased LOS and money savings, but they also want pt/family satisfaction, so we don't call hospice right away to transfer out of hospital unless the pt is sitting there talking to us.Since we do have our own hospice, they can do GIP on a med/surg floor if pt meets criteria. So it works all the way around.

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