From the Guidelines
In Florida, there is no specific law mandating that facilities must automatically send hospice patients to the hospital after a fall, and the decision should be based on the patient's advance directives, the hospice plan of care, and medical necessity. For hospice patients, their care plan typically emphasizes comfort rather than aggressive medical intervention. When a fall occurs, facility staff should first assess the patient for injuries, document the incident thoroughly, and consult with the hospice team and the patient's physician. If there are signs of serious injury such as uncontrolled bleeding, suspected fractures, head injury with altered consciousness, or severe pain, transfer to a hospital may be appropriate despite hospice status. However, unnecessary transfers should be avoided if they contradict the patient's expressed wishes or hospice goals. Facilities should have clear protocols for fall assessment that respect both their duty of care and the patient's end-of-life wishes. Communication between the facility, hospice providers, physicians, and family members is essential to ensure decisions align with the patient's best interests and stated preferences regarding emergency care.
Key Considerations
- The patient's advance directives and hospice plan of care should guide decision-making regarding hospital transfer after a fall 1.
- Medical necessity, such as signs of serious injury, should also be considered when deciding whether to transfer a hospice patient to a hospital.
- Unnecessary transfers should be avoided to prevent contradicting the patient's expressed wishes or hospice goals.
- Clear protocols for fall assessment and communication between healthcare providers are crucial to ensure that decisions align with the patient's best interests.
Transfer Guidelines
- If transfer is necessary, it should be done in a way that prioritizes the patient's comfort and safety, as outlined in guidelines for safe transfer of patients with brain injury 1.
- The transfer team should be accompanied by a clinician with appropriate training and experience in the transfer of patients with acute brain injury.
- Monitoring during transport should adhere to published guidelines, and the transfer team should have a means of urgent communication.
Hospice Care
- Hospice care is defined as the support and care for patients and their families in the last phase of an incurable disease, with the goal of living as fully and comfortably as possible 1.
- Patients with nonneoplastic advanced lung disease may face difficulties in getting referred to hospice due to challenges in determining prognosis and lack of awareness about hospice eligibility criteria.
From the Research
Florida Regulations Regarding Hospital Transfer of Hospice Patients
There are no specific Florida regulations mentioned in the provided studies regarding hospital transfer of hospice patients from a facility after a fall.
Relevant Information on Hospice Care and Falls
- Studies have shown that falls can pose a serious threat to hospice patients receiving palliative care 2, 3.
- Factors that increase the risk of falls among hospice patients include a past history of falls, higher physical function, fear of losing independence, and difficulty asking for help 2.
- Existing fall prevention tools may not be suitable for hospice patients, as they are based on research in non-hospice settings and may conflict with the goals of palliative care 3.
- Patient safety incidents, including falls, can occur in hospice care and may be related to issues in clinical process, medications, family or caregiving, and administrative challenges 4.
General Information on Patient Safety in Hospice Care
- Improving safety in hospices is crucial, as they care for a large number of patients every year 5.
- Safety measures from other settings may not be applicable to hospice care, as they may focus on reducing morbidity and mortality rather than prioritizing comfort 5.
- A patient's goals and life expectancy, as well as the degree of responsibility shared among caregivers, should be considered when developing safety measures for hospice care 5.