Emergency department discharges directly to hospice: Longitudinal assessment of a streamlined referral program

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2024-09-20 DOI:10.1016/j.ajem.2024.09.049

Daniel W. Markwalter MD , Jared Lowe MD , Ming Ding MBBS, ScD , Michelle Lyman MD, MPH , Kyle Lavin MD, MPH

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引用次数: 0

Abstract

Introduction

80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice.

Methods

We implemented a QI program in September 2021 consisting of three components: (1) clarification and streamlining of referral workflows, (2) staff/provider education on hospice and workflows, and (3) electronic medical record (EMR) tools to facilitate hospice transitions. The primary outcome was the change in monthly ED-to-hospice cases pre- and post-implementation. We also calculated the monthly incidence rate of ED-to-hospice transfers. The secondary outcome was ED length of stay (LOS).

Results

202 patients completed ED-to-hospice transfers from January 1, 2019 to February 29, 2024. 98 patients transitioned from the ED to hospice before QI implementation, and 104 patients transitioned after implementation. We observed a slight but insignificant increase in the mean monthly ED-to-hospice cases from 3.16 patients per month pre-implementation to 3.47 patients per month post-implementation (P = 0.46). We found no significant difference in the monthly incidence rate of ED-to-hospice cases before and after implementation (P = 0.78). ED LOS was unaffected (P = 0.21).

Conclusion

In this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.

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急诊科直接向临终关怀机构出院：简化转介计划的纵向评估

导言80% 的美国人希望死在医院以外的地方，而临终关怀是提供此类护理的重要资源。急诊科（ED）是识别有临终关怀需求的患者并提供临终关怀服务的重要场所。本研究的目的是分析一项质量改进（QI）计划，该计划旨在增加从急诊科直接转诊至安宁疗护的患者人数，患者无需住院观察，也无需接受院内安宁疗护：(我们于2021年9月实施了一项QI计划，该计划由三部分组成：（1）明确并简化转诊工作流程；（2）对员工/医疗服务提供者进行安宁疗护和工作流程方面的教育；（3）使用电子病历（EMR）工具促进安宁疗护的过渡。主要结果是实施前和实施后每月急诊室到安宁疗护病例的变化。我们还计算了急诊室到安宁疗护转院的月发生率。结果202名患者在2019年1月1日至2024年2月29日期间完成了从急诊室到临终关怀机构的转院。在实施 QI 之前，98 名患者从急诊室转入安宁疗护，实施 QI 之后，104 名患者转入安宁疗护。我们观察到，从急诊室到临终关怀机构的每月平均病例从实施前的每月 3.16 例增加到实施后的每月 3.47 例（P = 0.46），增幅轻微但不明显。我们发现，实施前后急诊室到医院的月发病率没有明显差异（P = 0.78）。结论在这项迄今为止最大规模的关于急诊室直接出院到临终关怀机构的研究中，以工作流程优化、教育和 EMR 修改为重点的 QI 计划不足以对急诊室出院到临终关怀机构产生重大影响。未来要增加从急诊室到临终关怀机构的转院率，应研究改进患者识别的方法、院内临终关怀项目的影响以及与医院和社区团队的协调，以支持那些希望留在家中的患者接受居家护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.