Usability Testing of a Hospice Live Discharge Protocol (LDP)

Key Message : Study results found an explicit hospice Live Discharge Protocol (LDP) was user-friendly, enhanced discharge preparation, streamlined communication, and maintained connection through a six-month post-discharge follow-up call. Further, patients, caregivers, and clinicians reported feelings of support.

Abstract: Background/Rational: Although hospice eligibility is defined by a prognosis of six months or less, patients whose condition stabilizes or improves may be deemed ineligible for continued services resulting in a live discharge. These discharges can create disruptions in care continuity and emotional distress for patients, caregivers, and clinicians.(1,2) Despite these challenges, no standardized protocol exists to guide the live discharge process, resulting in wide variability in practices and inconsistent continuity of care.(3) To address this critical gap, a Live Discharge Protocol (LDP) was developed to promote coordinated transitions following hospice disenrollment.(4)
Objectives/

Purpose: This project tested the usability of a newly developed Live Discharge Protocol (LDP) for hospice agencies designed to 1) enhance patient and caregiver experience, 2) minimize care disruptions, and 3) support hospice providers in navigating the complexities of live discharge transitions.
Methods/Approach: The LDP was implemented across four U.S. hospice agencies for discharges due to extended prognosis (n=30). Semi-structured interviews with hospice providers were conducted after each discharge to explore usability, perceived utility, and implementation challenges. A second round of interviews (n=19) was conducted following the six-month post-discharge follow-up call. Thematic analysis was used for data analysis.(5)

Results: Providers found the LDP easy to use and valuable for ensuring comprehensive discharge preparation, particularly in coordinating community referrals for patients remaining at home. The post-discharge follow-up call was identified as a critical component, both in supporting hospice clinicians and maintaining continuity with patients and caregivers who may later re-enroll.
Conclusion/Implications: Hospice providers reported that the LDP streamlined the discharge process by ensuring comprehensive documentation of clinical equipment, referrals, and patient needs. The post-discharge follow-up call was viewed as a meaningful strategy to support patients, caregivers, and clinicians, by helping to maintain care continuity and facilitate potential hospice re-enrollment.

References: 1) Wladkowski SP, Wallace CL. The forgotten and misdiagnosed care transition: live discharge from hospice care. Gerontology and Geriatric Medicine. 2022 Jul;8:23337214221109984.
2) Wladkowski SP. Dementia caregivers and live discharge from hospice: what happens when hospice leaves? Journal of gerontological social work. 2017 Feb 17;60(2):138-54.
3) Wladkowski SP, Wallace CL. Current practices of live discharge from hospice: social work perspectives. Health & Social Work. 2019 Feb 1;44(1):30-8.
4) Wladkowski SP, Enguídanos S, Schroepfer TA. An explicit Live Discharge Protocol (LDP) to improve care transitions. Innovation in Aging. 2024 Dec 31;8(Suppl 1):550.
5) Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: Striving to meet the trustworthiness criteria. International journal of qualitative methods. 2017 Sep 28;16(1):1609406917733847.