Impact of a Scatter Bed Hospice Unit (SBHU) on Palliative Care Utilization in an Academic Medical Center

Introduction: Inpatient palliative units increase the utilization of palliative and hospice services, and are associated with greater patient and caregiver satisfaction, and lower cost at end of life. Not all hospital settings can accommodate a dedicated palliative unit due to limitations in space, staffing, and cost. An alternative model, such as the Scatter Bed Hospice Unit (SBHU), which disperses hospice patients amongst those requiring standard acute care has been proposed. Despite its potential, limited data exists on the effectiveness of this model. This initiative aimed to increase palliative and hospice utilization through implementation of a SBHU within an academic acute care facility.

Methods: In December 2022, a Scatter Bed Hospice Unit (SBHU) was implemented at an urban tertiary care hospital. Retrospective chart review was conducted of patients who received palliative care consultation during the six months prior to SBHU implementation (July"“December 2022) and the six months following implementation (January"“June 2023). The primary aims were to perform a pre-post assessment of the number of Geriatric and Palliative (GAP) consultations and patients discharged with hospice services. Secondary outcomes included documented goals of care discussions, patients with comfort measures orders, patients who expired without hospice enrollment, reasons for GAP consultation, and time from hospice referral to admission.

Results: There was a significant increase in GAP consults (p=0.0021) post-implementation of our SBHU. The number of patients discharged with hospice services, documented goals of care discussions, and patients with comfort measures orders all showed increasing trends (non-significant). Amongst patients with a comfort measures order, there was a significant increase in patients discharged with hospice services from 32.7% vs 44.7% post SBHU implementation (p = 0.02). Post-SBHU, the time from inpatient hospice referral to hospice admission decreased from nearly three days to less than one (p < 0.001).

Conclusions: The SHBU improved utilization of palliative and hospice services through increased consultation and overall hospice enrollment amongst terminally ill patients. Transition to hospice care is more efficient with this model as evidenced by decreased time from inpatient hospice referral to hospice admission post-implementation of the SBHU model.

Key Message: Implementation of an inpatient scatter bed hospice was associated with greater use of palliative care consultation, increased documentation of goals-of-care, increased hospice utilization, and reduced time from hospice referral to transition.