By Eric Shaban, MD, Regional Medical Director, VITAS Healthcare
Hospital readmissions near the end of life present several challenges.
- What are the best practices for patients with advanced illness who frequent your emergency department?
- What do patients, families, hospitals and payers want?
- What is your role as an emergency department clinician?
- What is the role of hospice?
The Hospital Readmissions Reduction Program was developed for a reason. Consider this: a third of Medicare patients readmit within 90 days; 1 in 5 Medicare patients readmits within 30 days. During the last month of life, about half of patients are in the ED, and almost 10% are there on their last day.
Partner with VITAS to Achieve Key Goals
When your hospital partners with VITAS Healthcare, patients with end-of-life needs get the right care. We can admit hospice-eligible patients directly from the ED, even when they are symptomatic.
Your hospital achieves key goals:
- Reduced ED overcrowding, readmissions, and observation periods
- Improved ED throughput and bed cycling
- Seamless transitions to post-acute care
- Improved patient/family-satisfaction metrics
Hospitals are penalized for suboptimal ED “core measure” outcomes, reduced patient/family satisfaction scores, and readmissions of seriously ill patients who may not want to be hospitalized. When surveyed, patients report their preferences to include:
- Optimal pain/symptom control
- Strengthening their relationships with family
- Decreasing their care-burden on family
- Autonomy and maintaining a sense of control
- Dying at home surrounded by loved ones
Yet readmissions often occur because of unmet discharge planning needs, subpar post-discharge care coordination, or insufficient outpatient or community-based follow-up, particularly when coupled with severe advanced illness.
Readmitted patients tend to be elderly with multiple comorbidities that contribute to their decline. Often they have not adhered to follow-up plans and may not be able to state their diagnosis or explain their medications.
Many of these patients are hospice eligible. Determining eligibility in the ED can fit into a busy clinician’s assessment and facilitate timely decisions about the most appropriate care or placement of patients with recurring symptoms and advanced illness.
Signs That a Patient Might Be Hospice-Eligible
- Frequent visits to the ED, hospital, or ICU
- Ongoing symptoms despite optimal treatment
- Declining functional status
- Development of delirium
- Declining renal function
- Use of inotropes
- Patient’s goals are for quality of life
- Answering “No” to the question: Would you be surprised if this patient died in the next 6–12 months?
When referred to hospice as soon as they are eligible, patients receive medical and psychosocial care to control their symptoms and improve quality of life. Care is brought to them where they live by an interdisciplinary hospice team. Continuous care is provided at home per Medicare guidelines, keeping patients out of the hospital.
Refer Hospice-Eligible Patients From Your Phone
VITAS has streamlined the hospice referral process with a mobile application for iPhone, iPad and Android users. You can refer patients with advanced illness to VITAS quickly and securely with a face sheet photo capture and a few clicks. We’re available 24/7, including holidays.