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Changing Institutional Culture Around Hospice Using LEAN Tools to Improve Hospice Utilization in a Veteran Population.

Authors
  • Yamarik, Rebecca Liddicoat1
  • Wenziger, Cachet2
  • Streja, Elani2
  • Pham, Angela Ngoc-Thao3
  • Wei, Kevin S3
  • Bedi, Bishen4
  • Asch, Steven5
  • 1 Long Beach Veterans Affairs, Long Beach, California USA. Electronic address: [email protected]
  • 2 Long Beach Veterans Affairs, Long Beach, California USA; Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California, USA.
  • 3 University of California, Irvine School of Medicine, Irvine, California USA.
  • 4 University of California San Diego School of Medicine, San Diego, California USA.
  • 5 Department of Medicine, Stanford University, Stanford, California USA; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA.
Type
Published Article
Journal
Journal of pain and symptom management
Publication Date
Oct 01, 2021
Volume
62
Issue
4
Pages
836–842
Identifiers
DOI: 10.1016/j.jpainsymman.2021.03.021
PMID: 33831462
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Longer hospice length of stay improves the palliation of symptoms, quality of life, and the dying process for patients and their caregivers. We used a Lean designed Rapid Improvement Event (RIE) to facilitate earlier entry into hospice. Our primary outcome was hospice length of stay. Secondary outcomes were avoiding unwanted inpatient utilization and hospice location. We conducted a five-day RIE utilizing Lean tools targeting the inpatient medicine wards. Hospice length of stay increased from a median (interquartile range [IQR]) of 11 (7,27) days prior to 37 (7,73) days following the RIE. Home hospice and outside Skilled Nursing Home (SNF) hospice use increased while use of the onsite VA hospice decreased. LEAN tools can be used successfully to improve end of life outcomes in an inpatient VA setting. The 90-day sustainment period following the RIE uncovers barriers to implementation and allows for adjustments to implementation. Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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