A Hospice Eligibility Checklist for Emergency Department Staff

By Joseph Shega, MD, Chief Medical Officer, VITAS Healthcare

Do you keep seeing the same chronically ill patients over and over at your ED? It might be time for hospice.

Hospice can give your readmitting patients the care they need while improving your ED’s quality metrics.

These conditions, guidelines and other factors may flag a hospice-eligible patient.

General Hospice Eligibility Guidelines

Consider hospice if a patient meets 2 or more:

• Dependent in 2-3 of 6 ADLs
• SOB or fatigue at rest/minimal exertion
• Multiple ED visits or hospitalizations
• 10% weight loss in 6 months
• Recurrent falls with injury
• Decreased tolerance in physical activity

Diagnosis-Specific Hospice Eligibility Guidelines

Sepsis

• Hospice-eligible but not previously identified

Prognosis worsens with the following complications:

• Vasopressors
• Mechanical ventilation
• Hyperlactemia
• Acute kidney injury
• Hepatic Injury
• Thrombocytopenia

Alzheimer’s Disease and other Dementias

Consider hospice if patient meets both:

1. Dependent in 3/6 ADLs
2. One of these complications:
   
   • Pneumonia
   • Recurrent UTI
   • Sepsis
   • Weight loss 10%
   • Two stage-3 or -4 pressure ulcers
   • Hip fracture
   • Swallowing difficulty
   • Feeding tube decision

Lung Disease

Consider hospice if patient meets both:

1. Dyspnea at rest and/or with minimal exertion while on oxygen therapy
2. One of these disease progressions:
   • Frequent ED visits and/or hospitalizations
   • Cor pulmonale

Cancer

Consider hospice if patient meets both:

1. Spends 50% of time in bed or chair during waking hours
2. No longer pursuing chemotherapy and/or immunotherapy

Heart Disease

Consider hospice if patient meets all:

1. NYHA Class III or IV (Fatigue, angina, or dyspnea at rest and/or with minimal exertion)
2. Multiple ED visits and hospitalizations
3. Not a surgical candidate

Liver Disease

Consider hospice if patient meets both:

1. INR > 1.5 and serum albumin < 2.5 g/dL
2. One of these complications:
• Recurrent ascites
• Spontaneous Bacterial Peritonitis (SBP)
• Hepatic encephalopathy
• Variceal bleed
• Weight loss 10%
• HRS