(103) Unlocking Hospice Benefits for UK Healthcare and Its Patients

Introduction: Barriers were identified at University of Kentucky HealthCare (UKHC) with patients admitted to ICUs that were unstable for transfer to its Inpatient Hospice Unit. This was due to patients’ impending imminent death secondary to either severity of their illness or process of withdrawal of life sustaining treatments. UKHC collaborated with a hospice organization in the community to create a Scatterbed (SB) model to provide floating hospice beds in the ICU, thereby extending Hospice services to patients with a greater need. A significant decrease in mortality index was observed at UKHC, from 1.08 in September 2021 to 0.60 in June 2023. Thereby improving UKHC's overall Vizient ranking from 55 to 20, and mortality ranking from 68 to 28 over one-year.

Methods: A dedicated SB Hospice team was created for ICU patients to receive comfort and symptom management through end-of-life. Service lines associated with the highest mortality were identified in order to target high impact areas first. SB Hospice was strategically piloted in the Medical ICU (MICU) due to its high mortality index of 1.50 and low utilization of hospice. It was then implemented to the next highest-ranking opportunity area, Trauma and Surgical ICU, and ultimately to all adult ICUs including Neurosciences, Cardiovascular and Cardiac Care ICUs.

Results: Since initiation in September 2021, 604 patients received hospice services that would not have otherwise, providing a hospital-wide decrease in mortality index from 1.08 to 0.60 over a 22-month period. Integrating hospice into our ICU teams changed the care pathway and standard of care at UKHC.

Conclusions: Formation of SB Hospice service demonstrates an innovative and patient centric model that allows UKHC to serve critically ill patients that would otherwise not receive hospice care. Benefits of hospice were not only reaped by UKHC patients and their families, but also by our nursing staff and providers through sharing the burden of providing end-of-life care with a dedicated hospice team. A notable decrease in institution-wide mortality index was observed from 1.08 in September 2021 to 0.60 June 2023 as SB Hospice was embedded into our patient progression model. Implementation of this service improved our overall Vizient ranking from 55 to 20, and mortality ranking from 68 to 28.