Telehospice Cases from the Trenches

Transitioning patients to telehospice from telehomecare and other strategies for making telehospice work.

1. Carol Eisenbraun, RN, St. Luke’s Hospital, St. Louis, MO, discusses her organization’s experiences in transitioning patients easily from home telehealth to home telehospice and the welcomed peace of mind that increased contact that telehospice brings to patients and their families:

   We have used the HomMed monitor many times with our hospice patients as they are first on home health then the home health staff have prepared the patient and family for hospice care. We find the monitor really establishes a peace of mind with the families and sometimes patients in having control over the illness. That “peace of mind” lends itself to the patient/family experiencing less anxiety and improved symptom management. At the end of the illness and as the patient moves toward the end of their life, the monitor of course becomes less important and when that happens, we remove them.

   We have had opportunities to use the systems prior to as well as during the patient’s hospice admission and to good effect. Many times we used this “tele-palliative” care approach to assist in the patient/family dynamics surrounding illness and terminal illness. I cared for a patient nearly 2 years ago with a cancer diagnosis; as her oxygen sat levels decreased, her family could follow the process and progress of her final journey with the knowledge that this was normal and not painful to the patient.

2. Stacey Wood, RN, Doctors Home Care, Camden, AR, discusses the value of regular tracking and the focused care that can be brought to hospice patients, keeping them at home and out of hospitals.

   When we think about what roles can be played in using telehealth tools on a daily basis, hands down it is getting more complete patient information. We use a telemonitoring that asks the patient a series of patient-specific questions.

   This programming allows the patients to answer questions according to their needs. And it allows us to see the patient based on clinical needs and not on projected visits. We can manage pain control, respiratory status, cardio status, etc.

   In one of our telehospice cases, we have a hospice patient who monitors himself regularly and we are then able to view his vital signs and adjust medications regularly according to the findings. He is end stage CHF. We have kept him out of the hospital for over a year. We are able to see if his symptoms are controlled based on our questions and his answers to them.

3. Sherry Sevier Rogers, RN, BSM, CHPN, Clinical Coordinator, Guthrie Hospice, Towanda, PA, notes an unusual means of increasing communications and extending the hospice team that worked well for a patient.

   Telehospice not only helps us and our patients to avoid ED visits and hospitalizations, it also helps keep them at home. We had a patient who lived alone in an apartment in elderly housing. She was end stage cardiac and had previous hx of frequent ED/MD visits. We set up the monitor, a med regime and a LifeLine unit that was linked to her elderly sister living one floor above her. With all of these interventions, we were able to keep her in her own apartment (alone) until just two weeks prior to her death, when she had to be placed at a SNF due to her complete dependence with ADLs. When we looked at her case after her death, we counted at least 13 episones where we avoided an ED trip. In our minds, telehospice was very successful.

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