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When the family first reached out, I'm wondering if you reached out to the doctor to ask if permissible to do a Hospice consult? There must have been some reason they reached out to Hospice, even though they wanted to "keep going". I'm wondering if the Hospice consult would have helped the family to have these discussions earlier instead of the last week of life?
How did the team determine the SW frequency on admission? Seems like the psychosocial needs of the patient and family suggest a need for a higher visit frequency
I agree Lori…
you mentioned SW supported with calls. How about joint visits to increase the team support?
did you consider adding early bereavement services for the daughter?
Does your organization have a Palliative Care Program? It might have helped to ease the daughter into Hospice by starting with Palliative Care so they could continue with treatment and then easing into hospice care with the introduction of those extra services (bereavement/psych-soc/etc)
if the daughter had mental health issues, perhaps reaching out to her MD might have been appropriate.
this was a challenging situation. you did as good a job as any
what level of bereavement risk did you feel the family had?
and how are they doing now?
From an outreach standpoint, how do we educate the public about the benefits of starting hospice sooner? Is it better to market directly to them, or to physicians?
we have had a similar situation in our inpatient facility. it has been very tough on our staff who understand the dynamic of the family's grief, but it does seem compounded right now during COVID
Great question, Michelle
I can say with 100% certainty that we’ve also had this pt/family situation multiple times over the years. Always a crisis, always challenging. Always shooting from the hip so to speak. There is no one right cookie cutter answer to these situations.
Can you talk a little bit about how you are structured with palliative care as part of your services?
doctors don't refer until they can 'see" that the patient is dying!
plan 9 months for births but sometimes neglect to plan for death. great to get out there and educate the community via the rotary club
Thank you so much for sharing this case!
Thank you all for the presentation and sharing.
We wanted to let you know that we've made it easier to submit case studies for future Project ECHO calls with an online SBAR form. Go to nhpco.org/projectecho to see the upcoming topic schedule and submit a case.
For these types of patient who have been reliant on blood transfusion and IVFs for a long time, we often have a discussion with pt/family at time they are initially referred to negotiate what types of treatment we will offer under hospice services. For example, we may offer one or two more blood transfusions after signing onto hospice if pt is able to get out to the outpt center for the transfusion.
Has anyone out there had success at educating physicians regarding the fact that we can do so much more for patients and families if we have months instead of days or weeks.
Great discussion today!
thanks for the presentation.
Great comments Lores! Thank you.
We are seeing reduced LOS, as if referrals are coming late.. not from patient/family resistance.. any others reflecting this pattern? We are wondering if Providers are not getting to see their critical patients.. or some other factor.. Thoughts?
My boss always reminds people that the Medicare benefit is one they worked their whole lives for...