Graduation Semester and Year
Summer 2026
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Kimberly Hatchel
Abstract
Introduction
Among Medicare fee-for-service hospice beneficiaries, the national live discharge rate increased from 16.9% in FY2021 to 19.1% in FY2025. At a Medicare-certified hospice agency in a southern state, the pre-intervention live discharge rate of 35.3% substantially exceeded national norms, with 68.7% of events representing patient-initiated revocations.
Methods
A pre-post quality improvement design guided by the Plan-Do-Study-Act framework was implemented over 8 weeks at a single site with 106 newly admitted hospice patients and 15 clinical staff. The four-component bundled intervention comprised Revocation Risk Assessment administration within 24 hours of admission, structured patient and caregiver education within 72 hours of admission, weekly registered nurse follow-up calls for patients classified as high risk, and interdisciplinary team review of patients classified as high risk.
Results
The post-intervention live discharge rate of 16.9% represented a statistically significant 52.2% relative reduction from baseline, χ²(1, N = 279) = 9.03, p = .003, φ = .18. All four process compliance measures reached or exceeded 96% by the final implementation week. Staff knowledge and confidence improved significantly (p < .001; d = 2.15 and d = 3.80, respectively), with knowledge gains confirmed by Wilcoxon signed-rank sensitivity analysis (p < .001). Family caregiver satisfaction increased significantly, t(94) = 10.26, p < .001, d = 2.09, 95% CI [1.59, 2.60].
Conclusion/Discussion
The bundled intervention was associated with a reduction to a rate below the FY2025 national aggregate rate during a period of rising national rates. Within the limits of a single-site pre-post design, findings support structured risk stratification, early education, and interdisciplinary follow-up as feasible components of an agency-level approach to preserving care continuity. Family caregiver satisfaction improved significantly as a secondary outcome. Because different caregiver samples were used before and after implementation and satisfaction scores were not linked to discharge disposition, the project could not determine whether satisfaction mediated the reduction in live discharges. Multisite replication is needed before broader adoption can be recommended.
Keywords
Hospice care, Live discharge, Revocation, Quality improvement, Bundled intervention, Caregiver satisfaction, Interdisciplinary team coordination
Disciplines
Nursing
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
White, Fiona P., "Reducing Live Discharges in Hospice Care Through a Bundled Intervention" (2026). Doctor of Nursing Practice (DNP) Scholarly Projects. 9.
https://mavmatrix.uta.edu/nursing_dnpprojects2/9