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Making the Rounds

Is It an Emergency? Or Is It Hospice?

Hospital emergency room staff cares for patient

What are best practices for terminally ill patients who frequent your emergency department? What do patients, families, hospitals and payers want? What is your role? What is the role of hospice?

The Hospital Readmissions Reduction Program was developed for a reason. Consider this: a third of Medicare patients readmit within 90 days; 1 in 5 Medicare patients readmits within 30 days. VITAS Healthcare, the nation’s leading hospice provider, can admit hospice-appropriate patients directly from the ED, even when they are symptomatic.

Refer your hospice-appropriate patient: Online | Mobile app | 1.800.938.4827

When your hospital partners with VITAS, patients with end-of-life needs get the right care. Your hospital achieves key goals:

  • Reduced ED overcrowding, readmissions and observation periods
  • Improved ED throughput and bed cycling
  • Seamless transitions to post-acute care
  • Improved family-satisfaction metrics

Hospitals are dinged for decreased “core measure” outcomes and reduced patient/family satisfaction scores, and seriously ill patients do not want to readmit. When surveyed, their preferences include pain/symptom control, improving their relationships with family rather than increasing their burden on family, not prolonging the dying process and maintaining a sense of control.

Yet readmissions are often due to a failure in discharge planning or insufficient outpatient or community-based care, as well as severe progressive illness. Readmitted patients tend not to have follow-up plans, and not be able to state their diagnosis or explain their medications. Once realized, such issues are easily remedial.

What signs tell you a patient might be hospice-eligible?

  • Frequent readmissions to the ED, hospital or ICU
  • Ongoing symptoms despite optimal treatment
  • Declining functional status
  • Declining renal function
  • Use of inotropes
  • Patient’s goals are for quality of life
  • Answering “No” to the question: Would you be surprised if this patient died in the next 6–12 months?

Check the hospice eligibility reference guide.

VITAS has streamlined the hospice referral process with a mobile application for iPhone, iPad and Android users. You can instantly refer patients with serious progressive illness to VITAS with a face sheet snapshot and a few clicks—available 24/7 including holidays. Download it for free at

When referred to hospice as soon as they are eligible, patients receive medical and psychosocial care to control their symptoms and improve quality of life. Care is brought to them where they live by an interdisciplinary team. Continuous care is provided at home when medically necessary, keeping the patient out of the hospital.