Hospice techniques for hospitalized patients provide better end-of-life care

January 22, 2014 by Bob Shepard, University of Alabama at Birmingham
Hospice techniques for hospitalized patients provide better end-of-life care

A study by researchers at the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham says using home-based hospice practices for terminally ill, hospitalized patients could reduce suffering and improve end-of-life care.

The study, published online Jan. 21 in the Journal of General Internal Medicine, is the first to show that palliative care techniques usually used in a home setting can have an impact on for those who die in a hospital.

"More than 75 percent of Americans say they would prefer to die at home, yet only about 25 percent do—the vast majority dying in hospitals or nursing homes," said Amos Bailey, M.D., director of the Safe Harbor Palliative Care Program at the Birmingham VAMC and professor in the Division of Gerontology, Geriatrics and Palliative Care in the UAB School of Medicine. "This study was designed to see whether home-based hospice practices could be successfully integrated into care in hospitals to improve the end-of-life experience for those who remain hospitalized at time of death."

The study, Best Practices for End-of-Life Care for Our Nation's Veterans, or BEACON, was conducted at six VA Medical Centers over six years between 2005 and 2011 and included more than 6,000 patients.

The multicomponent intervention included training hospital staff to identify actively dying patients, communicate the prognosis to patients and families, and implement best practices of traditionally home-based hospice care in the inpatient setting. The intervention was supported by an electronic order set—called a comfort care order set—and other educational tools to prompt and guide implementation.

"Our intent was to take best practices commonly used in home hospice and translate those to the hospital setting," said Kathryn Burgio, Ph.D., associate director for research at the Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center and professor in the UAB Division of Gerontology, Geriatrics and Palliative Care.

BEACON examined several variables such as orders and use of medications for pain or confusion. It encouraged a more homelike environment that allowed the family to stay with their loved one or allowed people to eat some of the foods and drink they particularly like. It suggested less emphasis on the use of bedside monitoring and invasive procedures.

The study developed a screening tool for medical professionals to better assess when death was imminent—within a few days or a week. The comfort care order set could then be added to the patient's treatment plan. The orders prompted medical staff to adopt typical hospice practices such as providing easier access to pain medications and allowing patients to sit up in a chair, particularly beneficial for those with heart or lung disease. If supplemental oxygen was needed, BEACON recommended its delivery through the least invasive means possible.

"We wanted an environment where the care given in the hospital was more like that available at home with hospice," said Bailey.

The research team then created a list of measureable process outcomes that could be used to assess the effectiveness of the BEACON intervention. They included reducing intensive care unit usage, use of appropriate medications for pain, anxiety and respiratory issues, need for restraints, and use of pastoral care or consultation.

"Every one of the 16 outcomes we measured improved after implementation of the BEACON intervention," said Burgio. "For example, orders for pain medication increased from 62 percent to 73 percent. The percentage of patients who had IV lines or feeding tubes was lowered. The percentage who received appropriate medication for confusion or congested breathing increased. These are all variables that help ensure a less painful, less stressful and more comfortable end-of-life experience."

Bailey says the comfort care order set is now routinely used at the Birmingham VA Medical Center, as well as the UAB Palliative and Supportive Care inpatient unit.

"The BEACON protocol could be used in any hospital, and an increasing number of facilities have begun to adopt similar plans based on our findings," said Bailey. "We have submitted a grant to expand the program into another 48 VA hospitals nationwide."

Explore further: Misunderstanding of palliative care leads to preventable suffering

Related Stories

Misunderstanding of palliative care leads to preventable suffering

December 13, 2013
A new review says palliative care's association with end of life has created an "identity problem" that means the majority of patients facing a serious illness do not benefit from treatment of the physical and psychological ...

Oncologists improve quality of care for cancer patients

October 29, 2013
A pilot initiative conducted at Mount Sinai Hospital offers compelling evidence that establishing standardized criteria for calling a palliative care consultation improves the quality of care for patients hospitalized with ...

Early emergency department palliative care consultations resulted in significantly shorter hospital stays

December 11, 2013
New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC and colleagues reporting in Journal of Palliative Medicine found that initiating a palliative care consult in the ...

Ill, older patients who rely on emergency room often live final days in hospital, study finds

June 4, 2012
Half of adults over age 65 made at least one emergency department (ED) visit in the last month of life, in a study led by a physician at the San Francisco VA Medical Center (SFVAMC) and UCSF.

Involving other providers in palliative care may help meet growing demand

March 6, 2013
As baby-boomers age and the number of people with serious chronic illnesses continues to rise, the demand for experts in palliative medicine is sure to outstrip the supply, according Timothy E. Quill, M.D., professor of Medicine, ...

New report evaluates palliative and hospice care in Ireland

January 23, 2013
Investment in end-of-life care has made Ireland a world leader in advancing palliative and hospice care but regional inequities persist, according to an evaluation report just published by the Dean of Health Sciences at Trinity ...

Recommended for you

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Teens likely to crave junk food after watching TV ads

January 15, 2018
Teenagers who watch more than three hours of commercial TV a day are more likely to eat hundreds of extra junk food snacks, according to a report by Cancer Research UK.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

Your dishwasher is not as sterile as you think

January 13, 2018
(HealthDay)—Your dishwasher may get those plates spotless, but it is also probably teeming with bacteria and fungus, a new study suggests.

Study reveals what sleep talkers have to say

January 12, 2018
A team of researchers with members from several institutions in France has conducted a study regarding sleep talking and has found that most sleep talking is not only negative in nature, but involves a large amount of swearing. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.