Breaking the Emergency Cycle by Going Home

Strong indicators that your patient could benefit from hospice care are an increased use of emergency department and hospital services, as well as increased burden of symptoms along with decreased overall function.   A way to evaluate this is to use your best judgment to answer the following question:

“Would I be surprised if in the next six months this patient was no longer with us?”

Your answer to the above question will further determine the appropriateness of hospice services for the given patient.

Pressure on Emergency Department (ED) Providers 

Emergency Department providers ideally should feel empowered and honored to implement treatment options for patients that they have recognized as near the end of life.  However, quality metrics such as ED throughput, hospital readmissions and others are placing a tremendous amount of stress and pressure on ED practitioners, as well as the acute care system, to provide quick, efficient, and high quality care to their patients.

As people live longer and medical technology advances, EDs are seeing elderly patients with numerous, advanced, chronic illnesses that progress simultaneously, through the top treatments—until they don’t. The ED staff is then faced with uncontrolled pain, dyspnea, delirium and functional decline that are results from conditions like heart failure, COPD, vascular disease or any combination thereof progressing.  Dementia furthermore makes the situation more complex, especially if the goals of care and advance directives have yet to be conveyed. The patient becomes an ED frequent flyer, leading to difficulties with wait times, throughput, observation utilization, and boarding.

How to Offer Our Patients a Better Life

By determining the frequent flyer patients early in the ED and hospital cycles, and moreover, punctually referring them to hospice care, we can offer them better lives. They can be at home, wherever it is that they call home, and an interdisciplinary team will bring all the necessary clinical services to them.  With the elimination of panicked emergency calls, the quality of life improves. Their families receive support that they need, ED teams are able to focus on emergent care, and we are able to begin the process of breaking the cycle.