New ER Program Helped More Patients Get Needed Hospice Care

2024-07-09

TUESDAY, July 9, 2024 -- One hospital's push to transition patients who are nearing the end of life from the emergency room to hospice care appears to be working.

After the program went into effect, 54% of ER patients at Brigham and Women's Hospital in Boston transitioned to hospice care within 96 hours. That compared to 22% before the program began in 2021.

Their findings suggest that such programs may help adults who present at the ER near the end of life avoid delayed or missed hospice care.

"When patients come to an emergency room near end of life, the default is typically to admit them to the hospital, engage them in conversations about goals and end-of-life care and potentially move them into hospice care," said first study author Dr. Christopher Baugh, an emergency department physician at Brigham and Women's. "However, this lengthy progress can take longer than the patient has left to live."

He said the new program helps doctors quickly identify patients who are eligible for hospice care and get them there quicker. In hospice care, attempts to cure a person's illness are stopped and the focus shifts to comfort care and family support.

For patients nearing the end of life, hospice can provide safe, comfortable and dignified care. But patients with complex diseases and treatments often end up in the ER and die there or after being admitted to the hospital, researchers said in background notes.

For the new study, they turned to an artificial intelligence algorithm that analyzes patients' electronic health data and flags potential hospice candidates. Instead of being admitted to the hospital, these patients were placed on observation status. Hospice decisions were made by patients and their family or caregivers, with guidance from hospital staff.

Hospice teams began providing care within one to two hours, the study found.

"It's been incredibly moving to witness the care delivered by our multi-disciplinary program, and the impact on patients and families," said senior study author Dr. Mallika Mendu, vice president of clinical operations and care continuum at Brigham and Women's.

She said the program provides meaningful support at a critical point in patients' lives, which can have a lasting impact on bereaved loved ones.

"Importantly, the program facilitates timely transition to hospice care as early as when they present to the ED, which is crucial during this current period of capacity crisis, in which patients have experienced delays in receiving care," Mendu added in a hospital news release.

Researchers stressed that on its own, the program does not fully address the challenges of aligning care with patients' end-of-life goals and helping them die with dignity. Having a legal document called a Medical Order for Life-Sustaining Treatment that codifies a patient's goals for end-of-life care was associated with a successful transition to hospice in both the test and control groups.

The findings were reported July 8 in the journal JAMA Network Open.

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