Reasons Hospice Patients Access Emergency Departments for Symptom Management

Saturday, 16 November 2013

Linda M. Quinlin, RN, MS, ACNS-BC, NP-C, ACHPN
Nancy Henne Batchelor, MSN, RN-BC, CNS
College of Nursing, University of Cincinnati, Cincinnati, OH

Learning Objective 1: Identify the wide range of issues including symptom management challenges, changes in functional status, and psychological changes which contribute to hospice patients accessing emergency departments.

Learning Objective 2: Illustrate hospitalization is costly, disrupts continuity of care, may result in unwanted medical treatment, and may be against the patientís goals of care.

Many hospice patients access the emergency department (ED) for symptom management during the last six months of life even though the more effective approach is to have symptoms managed by hospice providers.  Symptom management is a process of care affecting the end of life journey for many hospice patients.  Symptom management involves and impacts patients, families, caregivers and nursing staff.  When symptoms are not effectively managed, hospice patients often access the ED.  Visits to the ED are costly, disrupt continuity of care, may result in unwanted medical treatment, and may negatively affect the patient’s goals of care.  To prevent ED visits the hospice program must effectively manage symptoms at home with ongoing surveillance and responsiveness.  Families and caregivers play important roles in managing symptoms and emotional aspects of patient care, as well as in decision making at the end of life.  Evidence based solutions which address hospice patients accessing the ED rest on five basic principles of care:  respecting the choices of terminally ill persons; supporting their medical, emotional, and spiritual needs; supporting the needs of their family; helping them access health care resources; and building programs to provide them with the best end-of-life care.  This poster presentation will identify reasons hospice patients access the ED, with a focus on two hospice organizations (Hospice of Dayton and Hospice of Cincinnati) nursing staffs' perceptions of the symptom management needs of the hospice patient, caregiver, home care nurse, and organization.