MADISON, Wis. – A new UW Health initiative improves the hospital’s hospice care process to ensure patients receive the best, most coordinated care possible throughout their end-of-life journeys.
The initiative provides inpatient and emergency department hospice enrollment at University Hospital, ensuring that patients nearing the end of life receive timely, compassionate support and more coordinated care between the health system and the hospice agency.
This program, created in partnership with regional hospice organizations and hospital staff, aims to improve continuity of care for patients already getting care in the UW Health system, according to Dr. Jeff Pothof, chief quality officer and emergency medicine physician, UW Health.
UW Health has skilled, experienced and compassionate palliative care teams, but inefficiencies were identified at the time when the system needed to enroll a patient into hospice care, he said.
“It is difficult to have a loved one pass away in the chaos of an intensive care unit,” said Pothof, who is also a professor of emergency medicine, University of Wisconsin School of Medicine and Public Health. “With this initiative, we make it much easier to have a patient and their family in a quieter, more peaceful unit at the hospital, or based on the patient’s condition, a faster transition to home hospice, where they could be surrounded by family, providing a more peaceful space to experience the loss of a loved one.”
The initiative adopts a more holistic approach, starting in the emergency department. For example, a patient experiencing a stroke might arrive at the emergency department, but unfortunately, there is no way to reverse the patient’s stroke, and the prognosis becomes very poor. In the past, these patients, after discussion with the patient and family about transitioning to comfort care, would be admitted to the hospital for palliative care services. However, they would not have been enrolled in hospice, so the family wouldn’t have access to those additional resources hospice provides, Pothof said.
Now, UW Health involves hospice much earlier to ensure the patient can spend their final days in the most appropriate care environment for them, he said. This is important because while palliative care often supports patients who are nearing the end of life, it more broadly encompasses comfort care and support for patients experiencing serious illness or injury, focusing on quality of life, whereas hospice care is specifically designed for end-of-life care.
Another example would be if UW Health receives a patient who is admitted to the intensive care unit with severe sepsis and septic shock, a serious medical condition. The goal is for UW Health critical care teams to reverse the condition, but unfortunately, it is not always possible, and the patient and their family will often decide that comfort is a more important goal than cure, according to Pothof.
“As doctors, we often want to throw the Hail Mary pass and do everything we can for the patient, but sometimes that is not in the best interest of the patient,” Pothof said. “Sometimes it is more important to consider what a patient would have wanted and how we can transfer them to comfort-focused medical care if that is their desire.”
Previously, patients might have stayed in the intensive care unit during their final days, as it took time to coordinate hospice care. Offering inpatient or home hospice as an option early creates more space in the ICU for other patients who need that level of care, and a better experience for those patients who have comfort as their goal. UW Health always strives to make a positive impact for all patients at any point in their life journey, he said.
“This initiative encourages conversations between our care team and families to truly understand the patient’s care goals,” Pothof said.
The initiative began this summer, and many patients and families are utilizing this more efficient process, he said.
“UW Health may be best known for our ability to manage the sickest patients using the latest advancements in medicine and technology delivered by some of the most talented care teams you could find,” Pothof said. “But when our patient’s story may not end the way anyone had hoped, we strive to provide just as remarkable end-of-life care.”
