Decreasing Burdensome Transitions in Hospice Care by Increasing Nursing Visits

Author

Kristin S. Rivers, Jacksonville State UniversityFollow

Date of Award

Summer 2025

Document Type

DNP Executive Summary

Degree Name

Doctor of Nursing Practice (DNP) in Family Nurse Practitioner

Department

Nursing

Faculty Chair

Dr. Megan Moore

Preceptor

Dr. Michael Hanna

Abstract

Background: Burdensome transitions occur when hospice patients discontinue hospice services to seek hospital treatment, often disrupting end-of-life goals and creating distress for patients and caregivers. These transitions continue to rise throughout the country, highlighting the need for strategies to support patients in remaining at home throughout the dying process.

Purpose: This quality improvement project aimed to decrease hospital transitions by increasing nursing visits for hospice patients at high-risk for burdensome transitions.

Project Design: This quality improvement project used a Plan-Do-Study-Act methodology to form and implement an intervention to reduce burdensome transitions. Patients were already identified as low or high-risk through company-established protocols. Over ten weeks, any patient deemed high-risk was given at least three nursing visits weekly. The project data was collected and compared to ten-week periods in 2022 and 2023.

Results: Seventy patients were admitted and screened for risk status during the ten-week intervention period. Implementing three nursing visits per week for high-risk patients reduced burdensome transition rates to 6.2%, a decrease from 9.5% in 2022 and 11.4% in 2023.

Conclusion: These findings suggest that early risk identification and proactive intervention of increased nursing visits can reduce burdensome transition rates. Policy changes to reflect risk-based nursing frequency can reduce unnecessary hospitalizations for patients at the end-of-life.

Recommended Citation

Rivers, Kristin S., "Decreasing Burdensome Transitions in Hospice Care by Increasing Nursing Visits" (2025). Doctor of Nursing Practice Projects. 138.
https://digitalcommons.jsu.edu/etds_nursing/138