Decreasing Unnecessary Emergency Department Visits and Hospitalizations for Hospice Patients

Grant Application

Keith Lagnese, MD, Family Hospice & Palliative Care

Proposed Innovation

Hospice patients have a life expectancy of six months or less, requiring a very sensitive level of care. Hospice care strives to provide comfort and support the patient and family according to the patient’s last wishes, which generally does not include going to the hospital. Yet, hospice patients often end up in the emergency department (ED) due to falls, injuries, shortness of breath, cardiac events, and lack of clarity of hospice service. This can be costly, disruptive, and contradictory to the patient’s goals.

This project aims to use education, patient monitoring technology, and an Emergency Response Team (ERT) to decrease unnecessary ED visits and hospitalization of hospice patients.

Improvements in Action

Family Hospice & Palliative Care (FHPC) will educate patients, families, and staff on how to avoid unnecessary hospital trips and what to do during a perceived emergency. Educational materials — pamphlets with written guidelines and refrigerator magnets with instructions and a 24/7 FHPC number to call during emergencies — will be developed and distributed. Fliers also will be provided to ED staff about what to do if an FHPC patient is identified.

In addition, patient-tracking software will be used to send real-time alerts to FHPC staff when a patient is transported to an ED. An ERT team of patient care supervisors, clinical managers, and physicians will then investigate and deploy staff to ensure the patient’s needs are met at the hospital.

Outcomes

This project is expected to improve the patient experience by minimizing unnecessary care burdens and ensuring hospice patients receive the right care at the right time. A comprehensive process and outcomes evaluation will be used to determine what goals were met, the impact on patients, and whether any adjustments are needed. If successful, the project could be expanded to all hospice organizations within the UPMC Community Provider Services (CPS) umbrella, as well as the UPMC Home Health program.