Inpatient Hospice Services within the Walls of Yale New Haven Hospital

From the 2018 HVPAA National Conference

Crystal Clemons (Yale New Haven Health System), Scott Sussman (Yale New Haven Health System), Ian Schwartz (Yale New Haven Health System), Francine LoRusso (Yale New Haven Health System), Catherine Lyons (Yale New Haven Health System), Kathleen Kenyon (Yale New Haven Health System)

Background

Despite a rapidly aging population, Connecticut residents utilize hospice services less frequently than any other state. Connecticut is ranked 32nd for number of hospice admissions and ranked 51st for median and mean hospice length of stay. This indicates an opportunity to refer patients to hospice earlier and more frequently.

Objectives

To provide better end of life care for patients within the walls of our institution and support to their families. To shift the culture by providing physicians with additional expertise in end of life care and support to nursing as they care for those at the end of their life.

Methods

Yale New Haven Hospital partnered with VITAS Healthcare to develop an inpatient hospice program. VITAS Healthcare is a national provider of end of life care, offering a full spectrum of hospice care and services. An interdisciplinary team of physicians, nurses, pharmacists, social workers, care managers, clergy, IT, and bed managers developed a workflow that would support transitioning a patient from inpatient status to hospice status. This workflow included providers having a goals of care and hospice discussion with patients and families. Social Work and Spiritual Care would be available to provide support to patients and families while our Care Management team would enter the hospice referral. Once the patient has elected their hospice benefit with VITAS Healthcare, the IT and bed management team ensured the patient’s status was appropriated coded on the back-end. Lastly, the multi-disciplinary care team would continue to collaborate to care for the hospice patient.

Results

Since its inception in April 2016, the inpatient hospice program has received nearly 1,800 referrals and provided end of life care to 768 patients. There are countless patient experience stories of how the inpatient hospice program has positively impacted these patients and their families.

Conclusion

The inpatient hospice program has proven to be a benefit to not only our patients, but also their families, and our medical and nursing staff. Having VITAS as a partner and expert in end of life care has given us the support to provide better care to our patients. Vitas is derived from the Latin word for “lives”. We are proud to stand with VITAS in efforts to preserve the quality of life for those who have a limited time to live.

Implications for the Patient

This program began as a pilot with only 4 available hospice beds. Due to positive patient and family feedback the program has expanded to Oncology, Transplant, Neurosciences, Neurosurgery, General Surgery and Pediatrics. All beds at both campuses are available for patients wishing to remain at the hospital with hospice care.

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