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A Quality Improvement Assessment of Emergency Department Visits by Hospice Home Care Patients

Batchelor, Nancy Henne DNP, RN-BC, CNS

Journal of Hospice & Palliative Nursing: October 2015 - Volume 17 - Issue 5 - p 442–449
doi: 10.1097/NJH.0000000000000182
Feature Articles

Estimates suggest that greater than 25% of Medicare resources are used in the last 6 months of life. One significant source of cost is related to emergency care delivered to hospice patients for symptom management near the end of life. As the first phase of a quality improvement initiative, the purpose of this project was to determine reasons for and prevalence of hospice home care patients who access emergency departments for symptom management near the end of life and to explore factors that may influence patients’ decisions to do so. A review of 1 hospice agency’s annual report data for 2011 indicated that 147 hospice patients sought emergency care many for symptoms that occur near the end of life, whereas a significant number of visits were attributed to falls and sequelae. Results of an investigator-developed survey distributed to home care nurses indicated that although written information was provided to patients and caregivers regarding what to do when changes in condition occurred, family/caregivers became anxious and sought emergency care. Revision of educational materials and development of strategies to address the needs of this population should inform future projects.

Nancy Henne Batchelor, DNP, RN-BC, CNS, is associate professor of clinical nursing, College of Nursing, University of Cincinnati, Ohio.

Address correspondence to Nancy Henne Batchelor, DNP, RN-BC, CNS, College of Nursing, University of Cincinnati, 240 Procter Hall, Cincinnati, OH 45221-0038 (

The author has no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.