Implementing Palliative Care Referrals For Patients Being Discharged From Hospice Services: A Quality Improvement Project

Background: Patients discharged from hospice services are not regularly or consistently offered palliative care referrals. Purpose/Specific Aims: The purpose of this project was to comprehensively explore the referral process from hospice to palliative care within the study institution, including barriers and enhancers. The project aimed to examine the referral processes and communication between hospice and palliative care teams, educate the hospice nurses on palliative care, and extend outreach to patients and families during the hospice discharge process. Methods: The gaps impacting the referral process were explored through a needs assessment. An educational intervention with a pretest-posttest design survey to assess palliative care knowledge was utilized with a convenience sample of 20 hospice Registered Nurses (RNs). Strategies to improve communication between levels and teams were implemented and palliative care outreach to patients/families was planned. Results: Hospice patients pending discharge were identified during weekly meetings. Barriers to referral were identified and an open-door policy to remove barriers to communication was established. Data entry of pre- and post-test knowledge scores were analyzed using Microsoft’s Excel. Mean scores increased from 63.8 on the pre-test to 87.6 on the post-test. A paired t-test was performed and was highly significant (p \u3c 0.001). Communication within and between teams was enhanced and palliative care nurse practitioners have reached out to patients and families to discuss palliative care after hospice discharge. Conclusion: These findings helped develop a culture change in the institution to embrace the importance of referrals to palliative care when discharging patients from hospice