A Pilot Trial to Increase Hospice Enrollment in an Inner City, Academic Emergency Department.
BACKGROUND
Hospice is underutilized, with over 25% of enrolled patients receiving hospice care for 3 days or less. The inner city emergency department (ED) is a highly trafficked area for patients in the last 6 months of life, and is a potential location for identification of hospice-eligible patients and early palliative care (PC) intervention.


OBJECTIVE
We evaluated the feasibility of an ED PC intervention to identify hospice-eligible patients to accelerate PC consultation and hospice enrollment.


METHODS
This prospective, pilot study established a program in the ED via education and a direct line of communication between the ED and PC to identify hospice-eligible patients, with the goal of facilitating disposition to hospice within 24 h. Data were analyzed for time to PC consultation, length of stay, emergency physician (EP) appropriateness of referral, and time from hospitalization to mortality.


RESULTS
In a 6-month period, EPs identified 88 hospice-eligible patients with 91% accuracy. Of the patients identified, 59% died within 3 months of their visit to the ED. Time to PC consultation was 2.3 days (SD 2.3), and 57% of those seen by PC were discharged to hospice, vs. 30% of those not consulted (p = 0.038). The potential median hospice length of stay was 31.5 days, better than for the institution as a whole.


CONCLUSIONS
Our pilot study presents a unique approach to early identification and disposition of hospice-appropriate patients, and suggests EPs may have sufficient prognostic accuracy to perform this task.
Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Bridget H
BH
Highet
Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Yu-Hsiang
YH
Hsieh
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Thomas J
TJ
Smith
D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017051:Hospice Care / Q000458:organization & administration*; D006738:Hospices; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards; D013997:Time Factors
emergency department; hospice care; palliative care; supportive care