Implementing a Standardized Workflow Process to Increase the Palliative Care to Hospice Admission Rate

Abstract

Hospice care is an underutilized medical benefit, with more than 50% of Medicare beneficiaries receiving less than 30 days of hospice service in 2018. Underutilization of hospice care decreases quality of life and contributes to higher healthcare costs related to uncontrolled illness-related symptoms. Ensuring timely hospice admission contributes to the Institute of Medicine's six aims of healthcare improvement. Palliative care patients transitioning to hospice care within this non-profit organization were experiencing extended wait times while transitioning to hospice care leading to uncontrolled physical, emotional, social, and psychological symptoms as well as death without the support of hospice services. This Doctor of Nursing (DNP) quality improvement project sought to determine whether implementing an evidence-based standardized workflow process with urgency levels and chart completion mandates could increase the hospice admission rate within 3 months of implementing the new workflow process. A convenience sample of all current palliative care patients n = 50 transitioning to internal hospice was used for this quality improvement project. This quality improvement project applied Lewin's change theory to understand the stages of organizational change and Deming's Plan Do Study Act (PDSA) cycle to implement the process improvement. Non-parametric statistical tests were used to analyze pre-post intervention data to evaluate the hospice admission rate outcomes. Data analysis concluded that more palliative patients were admitted to hospice and the average time from hospice referral to hospice admission was less in the post-intervention vs. the preintervention group. Standardizing the workflow process when transitioning palliative care patients to hospice services increases the admission rate and decreases the time to hospice admission allowing for early symptom management, improved quality of life, and lower healthcare costs.