Bringing Emergency Care to Hospice Patients in Their Homes

The caller, a family caregiver for a VNSNY Hospice patient, had phoned the patient’s hospice nurse manager to report that he was experiencing severe shortness of breath. A diuretic pill hadn’t helped, the caregiver said, and now she felt the only option was to have him taken by ambulance to the local emergency department.

In-Home Emergency Care for Hospice Patients

The VNSNY Hospice nurse manager knew that a 911 call would in all likelihood lead to a hospital admission—something no one wanted. She also saw from the patient’s digital records that he was enrolled in VNSNY Hospice’s new, cutting-edge community paramedicine collaboration with the Mount Sinai Health System. “Instead of calling EMS,” the nurse manager replied, “what if I called a paramedic who can get there within an hour and provide symptom relief?”

The family caregiver agreed. Thirty-five minutes later, a paramedic was standing in their home. After hooking the patient up to an oxygen tank and opening windows to let in fresh air, the paramedic phoned the VNSNY nurse manager and was immediately linked by phone with a VNSNY Hospice physician and a doctor at Mount Sinai’s emergency department. After consulting briefly, the two doctors instructed the paramedic to offer the patient morphine for additional symptom control. By this point, however, the patient was feeling so much better that he declined the medication. The VNSNY physician then arranged for a follow-up visit by a hospice nurse that evening and prescribed an extra dose of diuretics.

“It was a real success story,” says Dr. Ritchell Dignam, Chief Medical Officer for VNSNY Hospice. “The patient’s symptoms were relieved, and he was able to remain in a home hospice setting and meet his goals of care.”

An Innovative Approach to Home Hospice Symptom Management

Launched in January of 2018, the hospice community paramedicine collaboration operates in similar fashion to the community paramedicine initiative rolled out in 2017 by VNSNY Home Care and Mount Sinai: If a home hospice patient experiences a crisis when no medical professionals are present, the patient’s clinical manager can call Mount Sinai and summon a specially trained paramedic, who arrives at the patient’s home within 30 to 60 minutes. A VNSNY Hospice nurse then connects the paramedic telephonically to a physician team that prescribes palliative care measures, which the paramedic administers.

The main difference in the hospice program is its focus on symptom relief rather than treating the underlying non-curable condition. If more intensive symptom management is required, the paramedic will coordinate transfer or transport the patient to a VNSNY Hospice-contracted inpatient bed. The VNSNY and Mount Sinai teams meet to review each activation after the fact, and hold monthly calls to assess the program’s progress.

The initiative, which is the only one of its kind in the New York Metro area, is available to VNSNY Hospice patients in Manhattan, Brooklyn, Queens, and the Bronx.

Mount Sinai’s team, headed by emergency medicine physician Dr. Kevin Munjal, “has been a great partner,” says Dr. Dignam. “This approach provides an important added level of support for our patients,” she notes. “I think our initiative could pave the way for adoption of this type of additional support model by hospice programs across the nation.”