Page 105 - Business Development Orientation Binder

4/11/2019

SBAR Example

Ask referring physician if prognosis and patient’s wishes regarding
goals of care have been discussed.

Recommendation: Would you be agreeable to discussing Hospice with
the patient and wife as an option?

• Refer to hospice if physician is in agreement AND patient
and wife are agreeable.
• If “not ready” for hospice, document need for social work
(SW) referral once patient is admitted

Follow Up Steps

• PPS score 80% or greater, no clear indication of palliative or hospice care needs:
Standard CHHA services
− Follow standard intake procedures

• PPS score is 70% or below, core indicators and disease-specific indicators present, but
patient/family/MD NOT agreeable to Hospice referral: Document need for VNSNY SW
evaluation
− Document the PPS Score in coordination notes (and other info regarding ACP/Pall/Hospice
needs)

• PPS score is 70% or below, core indicators and disease-specific indicators present,
patient/family and MD agreeable to Hospice referral: Refer to Hospice
− Contact Hospice Liaison on site or Hospice Referral Center to make referral
− Cancel CHHA referral once patient is accepted by Hospice

• If there is a signed health care proxy (HCP), or other advance care planning
form in the hospital record, ask if patient can be sent home with a copy
• Attach copy of any advance care planning forms to Worldview

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