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Palliative care is the branch of healthcare that aims to provide symptomatic relief for patients with chronic or incurable medical conditions. Hospice is a subcategory of palliative care in which the focus is placed on comfort to the exclusion of further curative efforts, generally reserved for patients with a life expectancy of six months or less.

The American College of Emergency Physicians (ACEP) Choosing Wisely guidelines recommend that emergency physicians refer appropriate patients to hospice and palliative services. Preventing hospital admission in favor of transfer to an inpatient hospice unit “can benefit select patients resulting in both improved quality and quantity of life.” [1]

Additionally, from an operational perspective, especially in a system that deals with constant inpatient boarding in the ED, referral to hospice services can prevent acute admissions, opening beds both upstairs and in the ED to other patients. Similarly, CMS penalizes hospitals for return admissions within 30 days for such conditions as COPD/CHF. [2]

The population of South Philadelphia is a diverse group with a large burden of chronic illness. Increasing access to hospice services could allow both greater patient autonomy over their care as well as potentially bending the curve on hospital overcrowding and reducing readmissions.

By December 2018, we aim to institute a system of expedited inpatient hospice referral for patients presenting to our emergency department. Our goal was to increase the utilization of hospice services compared to prior years. Here we examine the initial effectiveness of this system in terms of utilization numbers on a rolling month to month basis.

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quality improvement, inpatient Hospice, emergency department, Jefferson Methodist Hospital


Medicine and Health Sciences | Palliative Care


Presented at the 2019 House Staff Quality Improvement and Patient Safety Conference

Expedited Referral to Inpatient Hospice Unit Through the Jefferson Methodist Hospital Emergency Department