Date of Award
3-2025
Degree Type
Dissertation
Degree Name
Doctor of Nursing (ND)
Department
Nursing
Chair
Monica Vasquez, DNP, APRN, FNP-C, WCC, ACHPN
Co-Chair
William L. Hull, DNP, APRN, NNP-BC, RNC-NIC, C-ELBW, DCSD
Abstract
Background: Timely transitions to hospice care remain a significant challenge in many healthcare settings, often resulting in patients transitioning too late to fully benefit from the services. Palliative interventions can improve care for patients nearing end of life, many patients do not receive timely palliative care (Perri et al., 2020). Delays in hospice referrals are frequently due to a lack of standardized processes for identifying patients nearing end-of life.
Objective: This is a Quality improvement project that aims to improve the timeliness and accuracy of transitioning new palliative care patients and existing Bridges High risk patients to hospice services by incorporating the Changes in Health, End-Stage Disease Signs and Symptoms (CHESS) scale alongside the current practice Palliative Performance Scale (PPS). The CHESS scale, designed to identify health decline in end-stage disease, can provide a more comprehensive assessment when combined with the PPS, which evaluates functional status. The goal is to determine if using both scales can help clinicians make more timely hospice referrals, improve predictive accuracy, and increase consistency in decision-making, intimately enhancing patient and family satisfaction with end-of-life care transitions.
Method: The Plan-Do- Study-Act (PDSA) cycle guided implementation over an 8-week period. Palliative care patients were screened using both the CHESS and PPS scales to determine eligibility for a Serious Illness Conversation (SIC) and possible hospice referral. Data was collected for the number of patients screened, referred, and transitioned to hospice, as well as overall feedback.
Results: Of the patients screened using both scales a significant improvement was observed in the number of appropriate hospice referrals compared to baseline. The dual-tool approach improved predictive accuracy and consistency in clinical decision-making. Barrier’s identified included patient and family readiness and absence of decision-makers during visits.
Conclusion: Incorporating CHESS with PPS improved the identification of hospice-appropriate patients, facilitating earlier referrals and enhancing the quality of end-of-life discussions. Standardizing the use of both tools may reduce variation in clinician judgement and improve patient and family satisfaction with hospice transitions.
Recommended Citation
Hernandez Garcia, Josefina, "Pathways to Peace: A Timely Shift to Hospice for Dignified End-of-Life Care" (2025). Cohort XIII. 12.
https://scholarworks.utep.edu/cohort_13/12