Effort is ensuring best care in most appropriate settings for more patients, families

November is Hospice and Palliative Care Month, and Yale New Haven Health (YNHHS) is marking gains over the past year that ensure we provide patient-centered care in the most appropriate setting for end-of-life patients and their families.

Last year, YNHHS included hospice optimization in a mortality improvement CORE initiative project. The fiscal year 2024 target goal was to have 55 percent of patients with a comfort measures-only (CMO) order evaluated and connected with hospice. YNHHS is currently at 50 percent.

“While we didn’t reach target, we’ve made significant improvements since FY23, when only 38 percent of eligible patients were evaluated and connected with hospice,” said Scott Sussman, MD, executive director, Office of the Chief Medical Officer, Yale New Haven Hospital, who leads the YNHHS hospice optimization initiative.

Part of the uptick can be attributed to continuing education for staff about the benefits of hospice, which can be provided at home, assisted living and skilled nursing facilities and hospice centers. Families ask about hospice more frequently now, in part because they want more control over what their end of life looks like, Dr. Sussman said.

In addition to supporting patients, the hospice team helps family members navigate grief and loss with outreach, support groups and other resources for 13 months after the patient’s death.

Statistics do show opportunities for improvement. In most non-ICU hospital units nearly 60 percent of eligible patients are connected with hospice. The number is lower for ICU patients, in part because things can change rapidly when managing critically ill patients, leaving less time to connect dying patients with hospice, Dr. Sussman said.

In response, ICU teams are working more closely with hospice partners to improve communication and collaboration. The hospice optimization team has streamlined ordering, documenting and transitioning a patient’s chart in Epic from inpatient to “general inpatient level of hospice care” for those unable to go home or to another hospice residence.

Clinicians can access multiple Palliative Care and Hospice Pathways in the Care Signature Clinical Pathways library under the Resources tab on the employee intranet or directly in a patient’s chart from the Pathways tab in Epic. The End-of-Life intranet page (under Departments & Communities) includes additional resources, such as tip sheets for hospice discharge readmit workflows; questions can also be directed to [email protected].

Hospice optimization FY25 goals include:

• Connecting more end-of-life ICU patients with hospice 
• Creating opportunities for patients to receive end-of-life care at home (if feasible and desired)
• Bringing education and resources so appropriate ambulatory patients desiring hospice can be referred sooner, for example, before going to the emergency department