Cooking in the Kitchen Together: Hospice and palliative care partnership to build a hospital-based GIP program

Key Message: Hospital-based general inpatient (GIP) hospice programs continue to grow, delivering symptom management, psychosocial support, and bereavement services to hospitalized dying patients and their families. In hospitals with robust palliative care programs, the hospice and the palliative care teams must proactively collaborate to navigate myriad issues and deliver high-quality, integrated care.

Abstract: Background
Health systems frequently contract with hospice agencies to deliver high-quality, compassionate end of life care through general inpatient (GIP) programs.(1) These programs can help identify patients in need of hospice care earlier in their hospitalization, facilitate improved symptom management in patients with significant disease burden, and give families access to bereavement services that may not otherwise have been available to them.(2) However, challenges arose when a hospice launched a novel, high-touch GIP partnership in a hospital with an existing, robust palliative care program. Primary teams did not know whom to call for a given patient, and, for patients with both teams involved, palliative care and hospice clinicians offered differing recommendations, based on their institutional practice patterns. Furthermore, hospices that provide this level of care face increased regulatory scrutiny that creates an administrative burden and financial risk. We worried these challenges would lead to fragmented, suboptimal care.

Approach
In this session interprofessional, interdisciplinary clinical and administrative leaders in palliative care, hospice, and health systems transformation will describe an ongoing process improvement project that led creation of a palliative care-hospice partnership to deliver integrated, team-based care at a large, urban academic medical center. Drawing on specific examples from clinical care and program development, panelists will describe challenges related to clinical integration, differences in approaches to symptom management, high-stakes patient-centered communication, documentation, and the complex regulatory environment. Panelists will then present successful strategies, with examples, to enhance communication and create sustainable, collaborative partnerships between hospices and palliative care program. These strategies include regular meetings, proactive structured communication around shared patients, and just-in-time debriefings after difficult cases.

Implications
As hospitals continue to partner with hospice agencies to create GIP pathways and programs, hospice and palliative care leaders and clinicians can work together to strengthen their relationships, streamline communication and, ultimately, improve care delivery.

References: 1. Chung K, Hughes MC, Koushkaki SR, et al. Hospice Capacity to Provide General Inpatient Care: Emergency Department Utilization and Live Discharge Among Cancer Patients. Am J Hosp Palliat Care. 2024;41(1):63-72. doi:10.1177/10499091231170598
2. Baugh CW, Ouchi K, Bowman JK, et al. A Hospice Transitions Program for Patients in the Emergency Department. JAMA Netw Open. 2024;7(7):e2420695. Published 2024 Jul 1. doi:10.1001/jamanetworkopen.2024.20695