Expanding the Care of Hospice Patients Across a Mobile Integrated Health System

Abstract

Transport demands for hospice patients are increasing, but mobile integrated health (MIH) providers report feeling ill-equipped to meet such demands due to the limited clinical guidance in their treatment protocols. This quality improvement (QI) initiative aimed to expand an MIH team’s capabilities of providing safe, comfortable transports for hospice patients by improving their knowledge of end-of-life (EOL) care. Primary interventions included deploying a hospice training program and clinical guidance through a comprehensive hospice patient treatment protocol for use in the transport setting. A continuous QI process accompanied the protocol implementation, which evolved through three Plan Do Study Act (PDSA) cycles over twelve weeks. Data were collected from provider assessments and patient documentation before and after the education program and protocol implementation and then analyzed to determine the effects of the interventions on hospice patients and MIH providers. Approximately 98% of hospice patient encounters reported improvement in comfort-related assessments and demonstrated protocol compliance. Provider clinical knowledge scores improved by an average of 37.66%. The amount of MIH providers reporting feeling uncomfortable providing care to hospice patients decreased by an average of 61.1%. MIH provider clinical competence in and comfort with providing EOL improved following dissemination of the hospice-focused education program and accompanying clinical guidance, each part of the QI initiative developed and implemented through a Doctor of Nursing Practice project.