Hospice Patients, 911 & Hospitals

Hospice & Hospital Fast Facts

• 1 out of every 5 hospice patients unenrolls from the hospice program.
• 25% of hospice patients that left the hospice program, or 6.7% of hospice admissions, resulted in hospitalization.
• Roughly 300,000 hospice patients unenroll of which over 100,000 hospice patients leave the program for hospitalization.
• The majority of these patients, especially those patients who left the program for hospitalization, will reenroll in the hospice program.

Check out the studies here & here.

Why Hospice Patients Go To The Hospital

When someone calls 9-1-1 and a hospice patient is taken to the hospital, the outcome is often poor, such as when CPR is performed on an elderly patient.

The philosophy of hospice is clear: Focus on the quality of life primarily through pain & symptom management, and stop curative and invasive treatments.

By enrolling in the hospice program the patient (or POA) has made their wishes clear, they want to focus on their quality of life and not pursue invasive treatments. Furthermore, most patients on hospice either already have POLST/DNR. If a patient is enrolled in hospice and does not yet have a POLST or DNR, the hospice agency will educate and work with the patient and family and caregivers to arrange for those forms to be completed.

While some 911 calls and hospitalizations are reasonable and unrelated to the patient’s terminal diagnosis, many hospitalizations are the result of well-meaning loving choices by people who do not know what to do.

While educating family members and caregivers on the nature of the patient’s disease and treatment is important, most family members are not clinicians. When faced with the urgent and immediate development in their loved one such as a change in breathing or breakthrough pain, almost no amount of education the hospice agency provides can overcome the lifetime of ‘call 911 in an emergency’ training. And often the person calling emergency services isn’t the patient or the caregiver that’s been educated by the hospice agency, for example, a daughters from out of town who came in for a visit. Anyone can call 911 and the first responders will respond. That’s their job.

The paramedics who respond are not judges and will not attempt to determine legal status or intent. They will assess the patient and based on their criteria, will perform emergency and invasive treatments and bring the patient to the hospital.

Minimize Hospitalizations

Emergency interventions and subsequent hospitalization for an issue related to the patient’s hospice diagnosis is not only problematic for the patient, it can create difficulties for the hospice agency as well. The patient needs to be discharged, team members will need to be rescheduled, the patient’s chart and billing need to be updated, it can be a hassle.

Education is key to reducing hospitalizations. The more your nurses educate family members and caregivers to recognize & handle clinical changes and treatment, the more likely they’ll hold off calling 911. Educating family members is also a component of your CHAPS survey.

However, hospice agencies can only do so much. Educating non-clinicians will only take you so far. And when someone is concerned in an urgent situation it is faster, easier, and more reflexive to call 911.

While hospice agencies may be limited in their resources to fully combat a lifetime of ‘call 911’ training, there are ways to manage the impact of a patient hospitalization. Most hospice patients who go to the hospital eventually return to hospice. Make it easy for them to return and make it easy on your team for the patient to be readmitted.

Easy Readmit

When the patient is ready to sign back onto hospice, there’s no reason to lose any information or require manual data entry.

Step 1. When a patient is discharged in the Hospice Tools eDocs EMR, a Create New Admission button appears on their intake page. When the patient is ready to be readmitted, click the button.

 

 

Step 2. Step 1 was pretty much it. All the intake, demographic, contact, financial and other previously held information info flows over. Here you have the new patient intake screen with an overlay quick view of the previous admission.

The system also prepares a new chart automatically:

With an easy view of previous charts through the drop down menu:

You can easily upload docs to the new chart and move docs from a chart to a chart and more.

Hospice patients going to the hospital is a fact that isn’t going to be changing soon. But with tools such as flexible scheduling, fast discharge and 1-click readmit, your team can keep moving forward and not get hung up on repetitive error prone manual entry work.

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