How Hospice Helps Emergency Medicine

Emergency department (ED) clinicians often encounter seriously ill patients who are nearing the end of life or are readmitted for chronic recurring symptoms and complex needs.

Frequently, these are patients who would prefer to die at home,¹ but their symptom burden, symptom exacerbation or caregivers’ concerns bring them to the emergency department, frequently referred from home healthcare services or skilled nursing facilities.

As your hospice partner, VITAS provides the staffing and expertise to transition advanced illness patients directly from the ED to VITAS for hospice care at home or another appropriate care setting.

Why Should Emergency Departments Refer Patients to Hospice?

Emergency medicine clinicians often encounter advanced illness patients who are readmitted for chronic, recurring symptoms and complex needs. VITAS provides complex modalities for patients who require higher levels of hospice care, supporting them with seamless transitions out of the ED and our unique ability to manage symptoms at home or during a short stay in a general inpatient hospice unit.

Like ED staff, VITAS team members also are available 24/7/365 for hospice evaluations, consultations and admissions, freeing up busy ED staff at all hours of the day or night, including weekends and holidays.

VITAS-provided complex modalities include:

• Intravenous therapies, paracentesis, thoracentesis
• PEG tube care and tube feedings
• High-flow oxygen, chest tube/PleurX, BiPAP, CPAP
• Compassionate ventilator withdrawal
• Tracheostomy care
• Proactive wound care/management
• Palliative-only symptom/pain relief
• Open formulary
• Extra layers of support from full-time medical directors, respiratory therapy, PT/OT/speech therapy, nutrition counseling and more

When Is It Time to Refer an ED Patient to Hospice?

ED visits often mark an inflection point in an illness trajectory signaling a more rapid rate of decline.² In fact, approximately 75% of older adults with serious, life-limiting illnesses visit the emergency department during the final 6 months of life.¹

Consider a hospice referral for patients who are experiencing:

• Declining functional status and worsening symptom burden in spite of ongoing treatment
• Advance directives that indicate a patient’s preference for quality of life over continued medical interventions
• A “no” answer to the question: “Would you be surprised if this patient died in the next 3-6 months?”

Care coordination by VITAS transitions patients seamlessly to hospice care at home. When symptoms and pain can no longer be managed at home, VITAS can provide care in a freestanding inpatient hospice unit or general inpatient beds at a local hospital or skilled nursing facility.

Hospice is the only secondary site of care that offers four levels of care to match patients’ clinical needs.

More Resources About Hospice and Emergency Medicine:

• A Guide to Hospice for Emergency Department Staff
• Is It Emergency, or Is It Hospice?
• ED Physicians Are Uniquely Placed to Assess Patients' Hospice and Palliative Care Needs

¹Kaiser Family Foundation/The Economist Four-Country Survey of Aging and End-of-Life Medical Care (2017). Conducted March 30–May 29, 2016.

²ED visits often mark an inflection point in an illness trajectory signaling a more rapid rate of decline.