Hospice Social Worker and Nurse Perceptions of the Usability of a Hospice Live Discharge Protocol (LDP)

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Abstract
Background: Live discharges from hospice are often distressing for patients, caregivers, and hospice providers alike, disrupting care continuity and leading to emotional and logistical challenges. Despite Medicare’s discharge planning requirement, no standardized process currently exists for hospice-initiated discharges, resulting in variable quality of care transitions. In response, a Live Discharge Protocol (LDP) was developed; however, the usability of this protocol in practice has not been evaluated. Methods: Purposive, convenience sampling occurred over 1 month. Participants were hospice social workers (n = 10), and hospice nurses (n = 10) recruited through professional networks and social media. Open-ended survey questions were used, and data was analyzed using conventional content analysis. Results: Across all four steps of the LDP, no concerns with the clarity of language, instructions, and flow of the LDP were reported; however, challenges in implementation were noted across steps. Specifically, collaboration with team members and having clear roles, managing the logistics of discharge, supporting the patient/caregiver reactions to the discharge, and incorporating a new practice into existing work structure. Conclusions: An explicit Live Discharge Protocol has strong potential to enhance the quality and consistency of a live discharge from hospice care. The LDP provides a framework to help smooth the transition from hospice care and provides patients and families with post-discharge support. Feedback from hospice professionals affirmed the relevance and usability of each step within the LDP, while also identifying opportunities for refinement for future implementation.
Funding Information
  • Cambia Health Foundation

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