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Fast Fact and Concept #139
Hospice Referral - Moving from Hospital to Home
Author: Tara Friedman |
The transition from hospital to home for the
patient about to be enrolled in home hospice care is complex.
Miscommunication between hospital staff and hospice care providers
regarding goals of care and medications occurs commonly and only heightens
existing stress and fear among patients and their caregivers. This Fast
Fact reviews key steps in the transition from the acute care hospital
setting to home hospice care.
Clarify Goals
Fast Fact #38 reviews key do’s and don’ts of the initial hospice
discussion with patients and families. Prior to discharge additional steps
to clarify the goals of care include:
* Confirm in the records that you believe the patient meets hospice
eligibility requirements—(see Fast Fact #82). “in my medical judgement,
the patient has a prognosis of less than 6 months if the disease follows
its usual course”.
* Review all a) medications and b) interventions (e.g. tube feedings, oral
antibiotics). Any medications and interventions that do not help the
patient and family meet their goals of care nor enhance quality/comfort
should be discussed with patients/families, and a recommendation made to
discontinue.
* Project ahead to the coming days-weeks—what symptoms/problems do you
anticipate will likely occur (e.g. dyspnea in a lung cancer patient). Ask
yourself if the current medications/interventions will likely meet these
needs or do additional medications/ interventions need to be made
available in the home.
Contact the Hospice Agency
Whoever makes the initial contact with a hospice agency (physician,
discharge planner, palliative care nurse, etc.) should have the following
information in hand:
* Patient’s address--confirm the patient lives within the hospice’s
catchment area.
* Birth date and medical insurance information
* Terminal diagnosis (e.g. dementia, cancer)
* Name of physician who will be physician of record for hospice care
* Overall goals of care and special issues (e.g. family needs special
bereavement support for children who live in the home or patient has two
days of palliative radiation left)
* Medical equipment needs (e.g. hospital bed, oxygen)
* Anticipated discharge date/time
Coordinated Discharge
* Whenever possible, have the someone from the hospice program meet the
patient and their caregiver in the hospital prior to discharge to review
hospice eligibility and covered services. If not feasible, arrange for the
initial hospice referral visit to occur when the patient arrives home, or
within 24 hours of hospital discharge at the outside.
* Include the hospice staff in the discharge plan.
* Review symptoms and confirm treatments for the terminal illness with
hospice staff
* Review symptoms and confirm treatments for diseases unrelated to the
terminal illness
# Plan to have durable medical equipment (DME) and medications available
when the patient arrives at home--coordinate this with your hospice agency
provider. Note: most hospice agencies need at least 24 hours to coordinate
the delivery of these items to the home.
With careful planning, the stress of transitioning to home hospice care
will be minimized, allowing your patient, their families and yourself, the
opportunity to focus on important issues near the end of life.
References
Fast Fact #82 Turner R. Medicare Hospice Benefit: Part 1 Eligibility and
Treatment plan. www.eperc.mcw.edu
Fast Fact #38 von Gunten CF. Discussing Hospice. www eperc.mcw.edu
Copyright/Referencing Information : Users are free to download and
distribute Fast Facts for educational purposes only. Citation for
referencing: Friedman T. Hospice Referral, moving from hospital to home.
June 2005. End-of-Life Physician Education Resource Center
www.eperc.mcw.edu.
Disclaimer: Fast Facts provide educational information, this information
is not medical advice. Health care providers should exercise their own
independent clinical judgment. Some Fast Fact information cites the use of
a product in dosage, for an indication, or in a manner other than that
recommended in the product labeling. Accordingly, the official prescribing
information should be consulted before any such product is used.
Creation Date: 6/2005
Purpose: Self-Study Guide, Teaching
Audience(s)
Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6,
Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General
Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN,
Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Nurses
ACGME Competencies: Systems of care, patient care
Keyword(s): Terminal Care
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