How Do You Ethically Integrate a GIP Hospice Service into the Hospital?

Case An 86-year-old female with a history of metastatic pancreatic cancer and diabetes was admitted for chest pain and dyspnea and found to have an acute pulmonary embolism. The hospital course was complicated by gastric outlet obstruction. She continued to decline despite maximal medical intervention and required intravenous hydromorphone every two hours and scheduled intravenous antiemetics every six hours, despite a nasogastric tube to suction. The patient lacked the capacity to make medical decisions, so her son was assigned durable power of attorney. During goals-of-care conversations, the patient’s son felt this ongoing management was inconsistent with the patient’s wishes and agreed with shifting focus to comfort. The hospitalist consulted the inpatient hospice team to assess if the patient was appropriate for general inpatient (GIP) hospice.   Hospitalists and palliative care specialists at our health system regularly provide end-of-life care for patients, including symptom control and management of physical and psychosocial stressors. Patients with a life expectancy of six months or less are eligible to enroll in home hospice care at discharge, benefiting from care by a holistic and specialty-trained interdisciplinary hospice team. Similarly, GIP hospice provides holistic end-of-life care and family support in acute-care hospitals. Patients who are appropriate for GIP hospice services often have a life expectancy of hours to days, require care that cannot b...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines Uncategorized Source Type: research