Domain 1: Structure and Processes of Care: Guideline 1.8

Our project implemented an in-patient hospice service to meet the needs of patients and families who were not able to make the transition to home-based hospice care. Our multidisciplinary team developed a toolkit to initiate hospice services for appropriate in-patients meeting Medicare guidelines. It is intended to be shared with other facilities. Hospice and Palliative Care staffs create and integrate patient care plans that meet the needs of patients, families, visitors and staff.

Short Description

Guideline 1.8 Palliative care programs should have a relationship with one or more hospices and other community resources to ensure continuity of the highest-quality palliative care across the illness trajectory.

Action Steps

• Assembled a team of key stakeholders: in-patient nursing staff, hospice staff, pharmacy, respiratory therapy, admitting and registration staff, business office, case management, administration, and Hospitalist physician support.
• Developed an algorithm to define the steps needed for successful hospital discharge and in-patient hospice admission.
• Used experienced nursing staff from the in-patient environment and hospice environment to provide a “reality check” to the algorithm, with subsequent edits to the plan.
• Designed policies, procedures and education materials.
• Sought administrative support for the financial requirements to provide training.
• Created an educational program to educate physicians, hospital and hospice staffs on program goals, operational process, Medicare clinical criteria for in-patient hospice, communication skills and care issues for Hospice patients.
• Provided education as “just in time” training
• Identified champions from the hospital and hospice nursing staffs as a resource during implementation and made them available for problem solving during initial enrollment
• Created collaborative nursing teams from the hospital and hospice environment that have improved knowledge of each other’s practice, facilitating communication and improved patient care coordination.
• Performed formal “de-briefing” after each in-patient hospice admission to improve process and remove obstacles
• Defined, tracked and reviewed outcome measurements for success and areas of improvement.

Summary of Results/What Worked and Why

Since initiation of our project, twelve patients have been enrolled in our In-Patient Hospice Program. Our project has improved patient and family satisfaction, improved in-patient nurse to hospice nurse communication, improved symptom management, decreased cost and increased routine hospice referrals by thirty-three percent. The collaboration and teamwork between the acute care and hospice staff have made this a win-win for patients, families and physicians.