Partnering to Keep Hospice Patients Out of the Hospital

Hospice patients and their family members typically call 9‑1‑1 because they are symptomatic, frightened or alone—not because they want to go back into the hospital. Most of the time they are simply searching for additional support.

EMS teams recognize this. Terminally ill patients or their families are among those who call 9‑1‑1 most often. These “frequent runs”:

• Do not benefit the patient
• Put undue pressure on first responders
• Contribute to overcrowding of busy emergency departments
• Result in unnecessary hospitalizations

Because the role of hospice is to ensure in-home support and the most appropriate care possible for patients and families coping with terminal illness, collaboration between hospice and EMS benefits everyone. A pro-active meeting of the patient, family, EMS and hospice professional gives everyone an opportunity to assess the situation and get to know one another. That ensures that the patient gets the care they need, the caregiver’s fears are allayed and the EMS is fully informed if they get a call from this address.

VITAS Readmission Prevention Program

An example of this working partnership between hospice and EMS is the collaboration between VITAS Healthcare and Acadian Ambulance Service in Texas. According to Joe Brickner, VITAS director of market development, the Readmission Protection Program, “allows us to give a higher level of care to our patients and achieve a better level of satisfaction for the patient and family.”

VITAS flags the charts of patients most at risk of going back into the hospital. This determination usually happens at admission, when the patient’s hospice team meets to discuss the physical, emotional and spiritual needs of the patient and family. Factors include:

• Is the patient full code (no Do Not Resuscitate order in place)?
• Does the patient have a history of going to the ED? Do they verbalize a desire to call 9‑1‑1?
• Does the patient live alone?
• Does the patient or primary caregiver have a high level of anxiety?
• Is this the first time the patient is in a nursing home or assisted living facility following hospitalization?
• Has pain management delivery dropped from intravenous to oral?
• Does the physician report that the patient/family is in denial of the terminal prognosis?

Patients designated high risk receive an introductory visit by the ambulance service’s VITAS-trained paramedics and additional visits and calls from members of their hospice team, including the physician, nurse, hospice aide, social worker, chaplain and volunteer.

High-risk patients and caregivers are instructed to call Telecare®, the VITAS telephone triage system, rather than 9‑1‑1 if they need help. They wear a medical alert system synced with Telecare that is activated by the push of a button. When called, the Telecare clinician assesses the situation, recognizes the red-light code on the patient’s record and calls Acadian Ambulance and the patient’s VITAS nurse, all of whom meet at the patient’s bedside.

Under the direction of the VITAS team physician, the partner paramedics are authorized to administer appropriate medications, start IVs, give oxygen, provide nebulizer treatments and other interventions as needed. The VITAS nurse determines if the patient’s condition warrants Intensive Comfort Care^®, which provides shifts of continuous care in the home until the issue is resolved. For severe symptoms that need more aggressive management, the paramedics transport the patient to a local VITAS inpatient hospice unit. All of these choices avoid hospital or ED admission.

Meeting the Needs of a Changing Healthcare Marketplace

Partnerships such as the one between VITAS and Acadian Ambulance benefit hospitals, physician groups, insurers and other healthcare providers by lengthening the patient’s continuum of care.

“This type of program aligns with the changes in the marketplace and goals of our referral sources to keep patients in the most cost-effective setting,” explains Brickner. “In the first week of the program, we were able to keep six patients home, preventing them from having to go to the hospital.”

For the patients and families involved in collaborations like this one, the biggest benefit is knowing they are never alone and have the backup support to stay where they really want to be—home.