Hospice Advisors Case Study
Title: Hospital Hospices LOS
Company: Hospital and Hospice in Augusta, GA
Date: May 28, 2015
Problem: Very long LOS for Hospice Referrals Made in the Hospital
Presenting Issues/Challenges: The LOS on hospital hospice referrals was 13.3 days. The hospitals over all LOS is 4.9 days. Why the big difference?
Plan of Action:This hospice has been working with this hospital for a few years. They developed a comfortable relationship which led to the discovery that the Length of Stay on hospice referrals was more than double the regular LOS for the hospital.
A small work group of hospital and hospice staff went through a Fish Bone exercise to try and understand the root causes of this excessive LOS, and brainstorm some potential counter measures. The following table shows the results of that work.
| Potential Reasons | Counter Measures |
| 1. Case Management making a recommendation to the physician regarding a hospice referral. | 1. Assuring Case Management understand the basic triggers for the different disease states and eligibility to elect their hospice benefit. We can assist Case Management by doing a “silent” or observational assessment of the patients so that Case Management can be more decisive in their recommendation. |
| 2. Delays occur as physicians try to determine if a hospice referral is the path to go. | 1. In addition to the above, support physicians with targeted information on hospice by disease groups. Work with Chief Medical Officer to customize approach.
2. Support Hospitalist by developing more useful “tools” they can use to create a palliative care/hospice plan of care. |
| 3. Physicians do not like to deliver this type of “bad news” | 1. It truly is in the approach. Offer tips in phraseology to use.
2. The gift of hospice as opposed to a death sentence. 3. Hospice can collaborate with physicians and Case Management under the direction of the physician in talking with the patient and family. |
| 4. Families trying to come to grips with a hospice referral. | 1. Clear and comprehensible ways to use palliative care and hospice.
2. Support, support and more support from hospice team. |
| 5. Families process in selecting a hospice provider. | 1. Support Case Management to keep process tight. |
| 6. The hospice’s process in expediting the discharge home. | 1. Once family select hospice work for same day discharge home with hospice. |
After this process we worked on implementing the Counter-Measures in more subtle ways and through what we call “Aggressive Osmosis”. These means and methods geared towards change gradually yield results.
Outcome/Results:
After six months, the decrease in hospital hospice referrals went from 10.3 –days to 8.2-days. While this LOS is still very high, the trend is downward which is a positive outcome.
