260826 In-hospital hospice units: A novel approach to care in the final days

Monday, October 29, 2012

Zachary Binney , Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
Paul Desandre, DO , Department of Emergency Medicine, Department of Veterans Affairs, Atlanta, GA
Tammie Quest, MD , Department of Emergency Medicine, Department of Veterans Affairs, Atlanta, GA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Public health or related research

Learning Objectives:
1.) Describe patients dying in two in-hospital inpatient hospice units (IPUs). 2.) Assess the unitsí impact on hospital admissions for patients in their final days.

Keywords: End-of-Life Care, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a full-time student in the Department of Epidemiology set to receive my MPH in May 2013. For the past six months I have worked extensively with physicians and researchers in the Department of Epidemiology and Palliative Care Center on preparing this abstract. I took the primary role in collecting and organizing the data for this abstract; I also wrote and edited the abstract with vetting from an Epidmeiology professor and palliative care physicians.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3279.0: End of Life Care