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HospiceAka: Hospice Referral
- Indications: Examples of Terminal Conditions for which to consider Hospice
- Cancer
- Significant functional decline (e.g. Karnofsky Performance Scale score <50)
- Distant metastases or multiple tumor sites
- Cancer complications (e.g. Bowel Obstruction)
- Chronic Obstructive Pulmonary Disease
- Congestive Heart Failure
- NYHA Class III-IV with symptoms refractory to maximal medical therapy
- Dementia
- Minimally verbal, non-ambulatory, with assistance required in all ADLs
- Cancer
- Criteria: Hospice eligibility
- Patient chooses hospice for palliative care (not curative) and
- Medicare Part A eligible (or commercial insurance with similar benefits) and
- Terminal illness with less than a 6 month life expectancy
- Protocol
- Referral initiated
- Hospice referral is not limited to physicians, nurses, and social workers
- Family and friends may also refer a patient to hospice
- Hospice duration (not limited to 6 months)
- Certification period 1: First 3 months
- Certification period 2: Next 3 months
- Subsequent certifications: Increments of 2 months each
- Attending physician responsibility
- Responsible for primary medical care and admissions
- Physician or covering partners are readily available for phone consultation by hospice staff
- Orders prescriptions for patient's palliative care (many are on standing order)
- Attending physician billing criteria (Medicare, care oversight code)
- Physician who signed hospice certification does oversight and
- Physician does not recieve separate compensation from the hospice agency and
- Physician chart review, phone calls and care coordination exceed 30 minutes/month and
- Patient seen by physician or collaborating practitioner (e.g. NP) at least every 6 months
- Allowed services (typical misconceptions about Hospice)
- Hospice patients are not mandated to be DNR (some local agencies may require this)
- Hospice patients may reside at a nursing facility
- Conditions unrelated to the terminal illness may still be treated, including hospitalization
- Chemotherapy, radiation and blood transfusions are not excluded if palliative care
- Grief counseling for family for as long as 1 year after a patient's death
- Referral initiated
- Resources
- National Hospice and Palliative Care Organization
- References
hospice environment (C0019947) | |
|---|---|
| Definition (MSH) | Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family. |
| Definition (CSP) | facility that provides palliative and supportive care for terminally ill patients and their families. |
| Definition (NCI) | An establishment that provides palliative and supportive care for terminally ill patients and their families via physical, psychological, social and other forms of care |
| Concepts | Manufactured Object (T073) , Health Care Related Organization (T093) |
| MSH | D006738 |
| English | Hospice, hospice environment, Hospices |
| Spanish | centro de cuidados paliativos, hospicio |
| Parent Concepts | Residential Facilities (C0035186), Health care facility (C0018704), Community Health Services (C0009472), special hospital (C0020025), Residential institution (C0432588), Duplicate concept (C1274013) |
| Sources | AOD, CSP, MSH, MTH, NCI, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
Referral to hospice (C0584064) | |
|---|---|
| Concepts | Health Care Activity (T058) |
| English | Referral to hospice |
| Spanish | derivacion a centro de cuidados paliativos, derivacion al hospicio |
| Parent Concepts | Referral to establishment (C0583971), Duplicate concept (C1274013) |
| Sources | SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
