A Guide to Hospice for Emergency Department Staff

07/19/2017

Emergency Department staff working

Do you keep seeing the same chronically ill patients over and over at your ED? It might be time for hospice.

Hospice can give your readmitting patients the care they need while improving your ED’s quality metrics.

Here are conditions, guidelines and other factors that may flag a hospice-appropriate patient.

Click here to download this list (PDF) to print and hang in your ED.

General Guidelines for Hospice Eligibility:

  • Dependent in 3/6 ADLs
  • SOB or fatigue at rest/minimal exertion
  • Multiple ED visits or hospitalizations
  • 10% weight loss in 6 months
  • Recurrent falls with injury
  • Decreased tolerance in physical activity

Heart Disease:

  • Fatigue
  • Palpitations
  • Angina or dyspnea at rest or minimal exertion
  • NYHA Class III or IV
  • Ejection fraction < 20% as a guide
  • Not a surgical candidate

Lung Disease:

  • Disabling dyspnea:
    • SOB at rest/minimal exertion
    • Continuous oxygen or chronic oral steroids
  • Progressive disease:
    • Frequent ED visits
    • Frequent hospitalizations
    • Cor pulmonale

Cancer:

  • ECOG 3
    • Capable of limited self-care
    • Confined to bed or chair > 50% of waking hours
  • No longer receiving anti-tumor therapy

HIV/AIDS:

  • Viral load > 100,000 copies/ml and/or CD4 < 25 cells/mm with functional status
  • Mainly sitting/lying
  • Plus progressive disease:
    • HIV dementia
    • 10% weight loss in 6 months
    • Opportunistic infections
    • HIV-related cancer

Liver Disease

  • INR > 1.5 or serum albumin < 2.5g/dL with complication:
    • Recurrent ascites
    • SBP
    • Hepatic encephalopathy
    • Variceal bleed
    • Weight loss 10%

Alzheimer’s Disease:

  • Dependent in 3/6 ADLs with complication:
    • Pneumonia
    • Recurrent UTI
    • Sepsis
    • Weight loss 10%
    • Two stage-3 or -4 pressure ulcers
    • Hip fracture
    • Swallowing difficulty
    • Feeding tube decision
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