First, click here to watch my video recount of the “Hospice” ER Shift
Ok, well I am neither a good actor, nor producer but don’t let that stand in your way of receiving my message…Hospice care can be activated ANYWHERE within the healthcare system (and even outside of it) when the patient is ready!
The ER (besides the ICU and Surgery Suite) may be one of the most aggressive, intervention-focused areas in the house of medicine. So, if WE can do it, then ANYONE can do it (meaning, transition patients to hospice care when appropriate.)
Here are some tips from my Emergency Department:
ER docs like to look at algorithms. It’s the way we are trained, just open up any ACLS guideline and you will see what I mean. So, in our emergency department we have a sign at each doctor workstation which reads:
“Signs that a person may be ready for hospice care”
- Weight Loss
- Increased pain, nausea, fatigue or other symptoms
- Increased need for assistance
- Decreased alertness
- Increased hospitalizations
- Family exhausted from care-giving demands
(At the bottom of the sign are directions on how to make a referral).
2. Train your staff to screen for hospice readiness
My nurses ask all kinds of questions to patients during their initial screening:
“Do you have any religious, or cultural preferences that might affect your care today?
“Do you feel safe at home?”
“Would you accept blood products to save your life?”
So, you see, we are accustomed to asking deeply probing questions from the get-go, so why not also ask end-of-life screening questions:
“How many times have you been to the ER or hospitalized in the last 6 months?”
“Do you feel like your health is steadily failing with worsening symptoms?”
“Are you feeling tired from the amount of care-giving required for your loved one?”
Identifying the potential hospice-appropriate population goes along way toward getting them the care they need in a more timely manner.
3. Build relationships with local hospice providers
Our hospital has an affiliate relationship with a local not-for-profit hospice who serves as our preferred provider. RNs from this hospice have affiliate hospital privileges at our institution. So, if we call… they come. This takes a huge burden off of the ER staff in transitioning care– our role just becomes one of “screener”- we “screen” the patient and family for physical and emotional “hospice readiness” and then can simply call for a consultation.
OR, if we have a patient who desires another hospice who doesn’t have affiliate privileges, OR if we have a clear-cut, “I want to go home on hospice” patient, then we can simply call the hospice service of choice (make sure their numbers are readily available to the secretary) and have the hospice RN meet them at their home or home facility for intake.
So, the bottom line here is, if we can do it, anyone can do it.
How does your department or institution make hospice referrals easier? Please share!