Date of Award
Fall 2026
Degree Type
Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
First Advisor
Stewart-Glenn
Abstract
End of life care is often a difficult time for patients, families, and caregivers. Hospice is a valuable resource for individuals who are considered terminally ill and have a life expectancy of six months or less. Many patients who are near the end present to acute care settings for treatment needs. While there are several clinical indicators that may suggest hospice care is the best plan of care for a patient, identifying hospice appropriate patients can be difficult in an acute care setting and there are currently no numerical assessment tools available in the literature that provides a quick reference that indicates there may be a need for a hospice referral. An easy-to-use screening toolkit can assist bedside nurses to quickly identify patients who may benefit from hospice and alert the primary provider to consider a hospice referral as part of the patient's plan of care. Prolonging hospice referrals prevent patients from receiving the level of care they need for their illness. This is especially a concern in rural facilities that often rely on hospice services that are further away and require longer travel times to provide needed evaluations and patient care by hospice providers. In addition to the prolonged patient suffering, delayed hospice referrals may also result in monetary cost and decreased reimbursement from Medicare. Hospitals are penalized through the Centers of Medicare (CMS) by withholding monetary compensation through the CMS STAR rating system when patients expire while in their facility, even if they have a terminal diagnosis and are not expected to recover from their illness. However, if a patient expires while admitted to hospice services, facility mortality rates are not negatively impacted. This project is a quality improvement project that developed a toolkit utilized by bedside nursing staff to quickly identify patients who may qualify for hospice care, utilizing a numeric scoring system. Patients admitted to the rural facility were screened either by an emergency room nurse or the inpatient admission nurse. If the patient received a high score, the nurse notified the admitting provider of the patients score and awaited the provider's decision to consult hospice services. During the project implementation, the facility decreased inpatient mortality rates, increased general in-patient hospice admissions, and increased the number of patients discharged from the facility to hospice care.
Recommended Citation
Muse, Jessica, "Facilitating Timely Hospice Referrals Using a Screening Toolkit in a Rural Hospital: A Quality Improvement Initiative" (2026). Doctoral Projects. 22.
https://digitalcommons.lmunet.edu/dnpprojects/22
