In-hospital hospice units: A novel approach to care in the final days

Background: Of the third of Americans who die in hospitals, many can be cared for in in-hospital inpatient hospice units (IPUs). Objectives: Describe patients dying in two IPUs and the units' impact on hospital admissions. Methods: This observational study was conducted in one university and one community-based tertiary care center. A list of IPU patient admissions between 1/1/2011 and 11/30/11 was obtained from the hospice administrator's inpatient census. These were matched in the hospitals' decision support system (DSS) on full name and IPU admission date to hospital encounter numbers immediately prior. We included patients who were discharged from an inpatient (IP) unit or the emergency department (ED) to the IPUs and subsequently expired. Deaths were confirmed in hospital records. Data included demographics, death dates, and discharge locations abstracted from hospital and hospice records LOS was defined as billable days and represents the number of IP hospital days avoided. Direct costs per hospital day are the average for all CY2011 admissions from the hospitals' DSS. Results: 690 patient admissions and 584 (84.6%) confirmed deaths occurred in the IPUs. Mean age was 68 +/- 15 yrs; 54.1% were female and 43.7% African-American. 7.2% were transferred from the ED and 68.7% from the ICU. Mean IPU LOS was 3.2 days (SD 4.5). 1,893 inpatient days were avoided at an average direct cost of $1,929/day. Conclusions: IPUs offer end of life patients an alternative to hospital admission. Follow-up studies comparing quality and costs for patients dying in IPUs versus other hospital units are planned.