Hospice Advisors Case Study
Title: Home Care to Hospice
Company: Chicago, Illinois
Date: February 21, 2015
Problem: Limited Referrals from Home Care to Hospice
Presenting Issues/Challenges: I worked with a Hospital System who had Home Care and Hospice companies. The Home Care was 2,000 and the hospice census was 240. When I first started working for the hospice side of the house they only received 10 referrals from the Home Care side of the house during a 12 month period. A problem. When we assessed how many of the OASIS Assessment forms indicated they felt the patient would live 6 months or less we found 21% of the assessment indicated they felt they won’t. But yet, only a small fraction of referrals were made to hospice.
Plan of Action: The action plan was at both a macro and micro level. First, we started a process to create a culture of collaboration between the home care and hospice divisions to make sure patients and families received all the support and resources possible. Here were the salient steps in that change process.
1. Senior Leadership Agreement.
We held several dialogue meetings with the senior leadership staff of each division to create a “collective vision” for making sure that the home care patients with end-of-life care needs upon discharge from home care received a hospice referral.
This starts with writing a compelling opportunity statement. Then we formed an improvement work group described next.
3. Formed a PDCA Work Group.
We formed a work group of 3 home care staff and 3 hospice staff. Using the Plan Do Check Act process, the work group came up with a number action steps. Here are a few examples:
- Every patient identified by the OASIS Assessment form as having end-of-life care needs we’re placed on the hospice pending list.
- The home care nurses were given training on better ways to talk with patients and families during the assessment visit about end-of-life care issues.
- Joint visits between the home care and hospice nurses were made close to the time of the patient’s discharge. Each visit was customized based upon where the patient was at with their goals and feelings.
- A customized discharge plan was created to help with the transition from home care to hospice and the execution of the patient electing their hospice benefit.
- The work group create a set of metrics they measured and reported out of monthly.
Eight months into the PDCA work group implementation process, the following were noted:
- In the eight month there were 12 referral made to hospice.
- The census for the hospice increased to 272 from 240. Part of this increase was due to the PDCA group’s work.
- The Length of Stay also has started to increase for the hospice.
- The ability to help create a more seamless deliver system also helped reduce inappropriate readmissions to the hospital.
- A strong sense of collegiality and collaboration was created between the two divisions and had an antidotal reported effective of improving employee satisfaction.