• Rebecca Liddicoat Yamarik, Cachet Wenziger, Elani Streja, Angela Ngoc-Thao Pham, Kevin S Wei, Bishen Bedi, and Steven Asch.
• Long Beach Veterans Affairs, Long Beach, California USA. Electronic address: rebecca.yamarik@va.gov.
• J Pain Symptom Manage. 2021 Oct 1; 62 (4): 836-842.

BackgroundLonger hospice length of stay improves the palliation of symptoms, quality of life, and the dying process for patients and their caregivers. We used a Lean designed Rapid Improvement Event (RIE) to facilitate earlier entry into hospice.MeasuresOur primary outcome was hospice length of stay. Secondary outcomes were avoiding unwanted inpatient utilization and hospice location.InterventionsWe conducted a five-day RIE utilizing Lean tools targeting the inpatient medicine wards.OutcomesHospice length of stay increased from a median (interquartile range [IQR]) of 11 (7,27) days prior to 37 (7,73) days following the RIE. Home hospice and outside Skilled Nursing Home (SNF) hospice use increased while use of the onsite VA hospice decreased.Conclusions/Lessons LearnedLEAN tools can be used successfully to improve end of life outcomes in an inpatient VA setting. The 90-day sustainment period following the RIE uncovers barriers to implementation and allows for adjustments to implementation.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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