Tuesday, March 29, 2016

Do You Feel The Churn?

by Dr. Linda Liotti, D.O.

Do you feel the Churn?  Over the last thirty years, there have been changes in the hospice and palliative care industry. Years ago, nurses carried a case load of 12 – 15 patients. Each patient was seen on a regular basis, their needs and concerns taken care of by the nurse and multidisciplinary team on a weekly basis. Most patients would be followed until death, however a few graduated from hospice when the IDT found they had stabilized.

Recently speaking with several colleagues, we noted a trend which suggests the turnaround time from admission to death continues to shrink. When we attend the interdisciplinary team meeting to discuss admissions, there are times where greater than 50% of patients admitted in the past two weeks, have already died. This trend suggests a phenomenon where admission to pronouncement has escalated with several consequences.

First, is that nurses are spending 3+ hours to admit a patient and complete the electronic medical record (EMR) documentation. Before the social worker or chaplain have time to build a relationship, the nurse is already doing the pronouncement. This very rapid cycle leads to compassion fatigue and burnout for nurses, doctors and the rest of the team as the workload has become much heavier.

Compassion Fatigue

Compassion fatigue has been described as persistent stress and anxiety with feelings of being overwhelmed and hopelessness. Due to the increased time necessary to complete an electronic record, clinicians do not have time to bond with patients and families as well as they did in the past. Data from CMS for “Medicare only” patients for 2014 reveal:

  • Median Length of Stay (LOS) for New Jersey is 18 days, down from 19 days in 2013. 
  • Average LOS for NJ is 61 days, down from 63 days in 2013. 
  • Nationwide statistics are only slightly higher than New Jersey.
  • Median LOS and Average LOS for 2015-2016 are expected to be even lower.
One reason for short length of stay and last minute admissions seems to be late referrals. Suggested reasons include the impact that palliative care programs, Accountable Care Organizations (ACO’s), visiting physician services, and growing hospital systems have on the timing of the hospice referral.

What do you think?
  • Is the timing between admission and death shrinking? 
  • Do social workers and chaplains have enough time to get involved? 
  • Does this add to compassion fatigue and burnout for clinicians? 
  • What is the future of hospice and palliative medicine as mergers, acquisitions and consolidations continue? 
Join Us!

What: #hpm (hospice and palliative med/care) chat on Twitter
When: Wed 3/30/2016 - 9p ET/ 6p PT
Host: Dr. Linda Liotti and NJHPCO

Read more about burnoutcompassion fatigue and self-care on Pallimed.

Dr. Linda Liotti is a physician, and chair of the Education Committee at the New Jersey Hospice and Palliative Care Organization (NJHPCO). NJHPCO can be reached at (908) 

 and go to www.hpmchat.org for up to date info.

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For more on past tweetchats, see our archive here.

Photo credit: www.caregiverhelp.com

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