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Hospice Case Study: Hospital to Hospice Transition

Complete Care – A Comprehensive Hospice Solution

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Service: Hospice

Diagnosis: Liver Cancer (metastasized to the lung and bone) & COPD

Description

The patient—diagnosed with a life-limiting illness of liver cancer— had been on home health services since 2020. A severe decline led to a hospitalization that resulted in a transition from home health to hospice care. The patient’s liver cancer metastasized to the lungs and bones. The patient was experiencing a high level of pain given the complexity of the diagnosis.

Complete Care Approach

While in the hospital, the Constellation care team was able to coordinate with the hospital palliative care nurse for input and consultation regarding pain medications. After being released from the hospital into home-based hospice care, the Constellation care team managed pain with the guidance of a physician. Their goal was to provide the patient with maximum comfort while reducing invasive treatments. The patient was prescribed Ativan, Spironolactone and Lasix, and inhalers for anxiety, lower edema, and shortness of breath, respectively.

In Home Team:

Constellation’s hospice team managed the patient’s pain and avoided the use of a peripherally inserted central catheter (PICC) line while coordinating with various providers to ensure the patient transitioned successfully across care settings.

Key Outcomes

  • Worked closely with community partners to transition a clinically complex patient between care settings
  • Team worked to manage severe pain and avoid invasive treatments.
  • Supported the family virtually with phone calls from chaplain and social worker.

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