An evaluation of a pilot inpatient hospice unit and the impact it has on end-of-life care at an academic medical center
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Date of Graduation
Doctor of Nursing Practice (DNP)
School of Nursing
Jo Ellen Carpenter
Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.
Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact the GIP hospice unit had on end-of-life care at the hospital. Feasibility of the unit was assessed by patient admission characteristics and missed opportunities for admission to the unit. Patient charges were assessed to evaluate if there was a difference between patients that received end-of-life care in the GIP hospice unit compared to inpatient units in the hospital.
Interventions: A six-month evaluation of the pilot GIP hospice unit was done through a retrospective, cross sectional study design. The evaluation reviewed information from the Electronic Health Record (EHR), Vizient, Allscripts, and BiMart (internal financial system). The evaluation assessed if the GIP hospice unit affected recognition of end of life and patients that wanted hospice services through decreased Intensive Care Unit (ICU) length of stay and earlier hospice referrals (measured in days before death). Improved quality of end-of-life care was measured by the implementation of comfort care order sets.
Results: Between March 1st, 2019 and August 31st, 2019 there were 17 patients admitted the GIP hospice unit. There were 55 patient deaths at the hospital during that time that were identified as missed opportunities for admission to the GIP hospice unit. The most frequent reason for missed opportunities for admission to the GIP hospice unit was no or late referral to hospice (31%). There was a statistical difference between ICU length of stay between the pre-implementation group (mean 7.7 days, p <.05) and the post-implementation group (mean 4.5 days, p <.05). There was statistical difference between the initiation of the Comfort Care Order Set between the pre-implementation group (11%, p < .001) mean and the post-implementation group (43%, p < .001).
Conclusions/ Implications: The six-month evaluation found that the GIP hospice unit was feasible, had decreased laboratory patient charges, and impacted end-of-life care for patients on other units in the hospital. Based on the evaluation the hospital will continue to improve the referral and admission process to the GIP hospice unit and consider expansion of the GIP hospice unit to patients who require compassionate extubation.
Minetree, Cynthia, "An evaluation of a pilot inpatient hospice unit and the impact it has on end-of-life care at an academic medical center" (2019). Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019. 33.