ED-to-Hospice Referrals: A Baseline Survey of One Hospital’s Experience

Hospice and palliative care improve quality of life for patients with advanced illness, yet referrals from emergency departments (EDs) remain limited. This study aimed to establish a baseline rate of ED-initiated referrals from the Northwell’s Long Island Jewish Medical Center to its Health’s Hospice and Palliative Care Program between August and December 2024. Using an institutional database, we reviewed 262 referrals and identified referral sources, documentation of ED goals-of-care (GOC) discussions, and patient disposition. Only 5.3% of all palliative care referrals and 3.0% of actual hospice placement referrals originated from the ED, with a decline in ED GOC discussions over the study period. Nearly all referred patients were admitted or placed in observation rather than discharged home or directly to hospice. Persistent cultural, educational, and workflow barriers may limit integration of palliative care within the ED. Improved interdisciplinary communication, provider training, and structured ED-to-hospice pathways may increase appropriate referrals, reduce unnecessary hospitalizations, and promote goal-concordant end-of-life care. Establishing this baseline provides a foundation for future quality improvement initiatives aimed at enhancing patient-centered outcomes for Northwell patients with advanced illness.