Bereavement Support Services in a National Sample of Hospices: A Content Analysis

A Hospice Transitions Program for Patients in the Emergency Department

Importance

Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care.

Objective

To assess the association of hospice use with a novel multidisciplinary hospice program to rapidly identify and enroll eligible patients presenting to the ED near end of life.

Design, Setting, and Participants

This pre-post quality improvement study of a novel, multifaceted care transitions program involving a formalized pathway with email alerts, clinician training, hospice vendor expansion, metric creation, and data tracking was conducted at a large, urban tertiary care academic medical center affiliated with a comprehensive cancer center among adult patients presenting to the ED near the end of life. The control period before program launch was from September 1, 2018, to January 31, 2020, and the intervention period after program launch was from August 1, 2021, to December 31, 2022.

Main Outcome and Measures

The primary outcome was a transition to hospice without hospital admission and/or hospice admission within 96 hours of the ED visit. Secondary outcomes included length of stay and in-hospital mortality.

Results

This study included 270 patients (median age, 74.0 years [IQR, 62.0-85.0 years]; 133 of 270 women [49.3%]) in the control period, and 388 patients (median age, 73.0 years [IQR, 60.0-84.0 years]; 208 of 388 women [53.6%]) in the intervention period, identified as eligible for hospice transition within 96 hours of ED arrival. In the control period, 61 patients (22.6%) achieved the primary outcome compared with 210 patients (54.1%) in the intervention period (P < .001). The intervention was associated with the primary outcome after adjustment for age, race and ethnicity, primary payer, Charlson Comorbidity Index, and presence of a Medical Order for Life-Sustaining Treatment (MOLST) (adjusted odds ratio, 5.02; 95% CI, 3.17-7.94). In addition, the presence of a MOLST was independently associated with hospice transition across all groups (adjusted odds ratio, 1.88; 95% CI, 1.18-2.99). There was no significant difference between the control and intervention periods in inpatient length of stay (median, 2.0 days [IQR, 1.1-3.0 days] vs 1.9 days [IQR, 1.1-3.0 days]; P = .84), but in-hospital mortality was lower in the intervention period (48.5% [188 of 388] vs 64.4% [174 of 270]; P < .001).

Conclusions and Relevance

In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.

The Current Status of Bereavement Care in Chinese Emergency Departments: A Multicenter Cross-Sectional Study

Understanding the current status and challenges of bereavement care will help facilitate the development of bereavement care in the emergency department. However, little is known about the status of bereavement care in Chinese emergency departments and nurses' perceptions of bereavement care. We used a self-made questionnaire to survey 124 head nurses and 870 emergency nurses in 21 hospitals in Jiangsu Province in September 2023. Among 124 emergency departments, 78 (62.90%) emergency departments provided bereavement care strategies, and the most frequent strategy was a waiting room, relevant information on funeral arrangements and the establishment of a relatively secluded environment conducive to the solace of the patient's family, or the provision of a dedicated farewell chamber. Emergency nurses believed that bereavement care is important but difficult to implement, with support resources, environment and human resources being the main challenges. In the future, further attention should be paid to the development of bereavement care in the emergency department, and the implementation of bereavement care should be supported in terms of policies, funds, resources and personnel.

Grief Coach, a Text-Based Grief Support Intervention: Acceptability Among Hospice Family Members

U.S. Medicare-certified hospices must provide bereavement care to family members for 13 months following a patient's death. This manuscript describes Grief Coach, a text message program that delivers expert grief support and can assist hospices in meeting the bereavement care mandate. It also describes the first 350 Grief Coach subscribers from hospice and the results of a survey of active subscribers (n = 154) to learn whether and how they found the program helpful. The 13-month program retention rate was 86%. Among survey respondents (n = 100, response rate = 65%), 73% rated the program as very helpful, and 74% rated it as contributing to their sense of being supported in their grief. Grievers aged 65+ and males gave the highest ratings. Respondents' comments identify key intervention content that they found helpful. These findings suggest that Grief Coach may be a promising component of hospice grief support programming to meet the needs of grieving family members.