Clinical Indicators

Clinical Indicators for Providers

Minnesota Hospice wants to make the transition to hospice care easy and stress-free for patients, families, and medical professionals. We understand determining hospice eligibility can be challenging. Our goal is to provide you with the clinical information you need regarding eligibility, along with a simple referral process to ensure the best possible outcomes for your patients with advanced life-limiting illnesses and their loved ones.

Referral Process

Fax

Please send the following information to our secure Intake Fax Line at 651-796-9005.

Face Sheet
Signed Physician Order, stating “Ok to eval and treat for hospice”

Call

Call Minnesota Hospice which is answered 24/7 at 952-898-1022.

Emergency Assistance

If an emergency admission is required, please fax the following information and call us which is answered 24/7 at 952-898-1022.

Patient full legal name
Patient date of birth
Patient address
Patient social security number
Patient Medicare number
Diagnoses
Signed Physician Order, stating “Ok to eval and treat for hospice”

General Clinical Guidelines

Hospice-appropriate individuals may exhibit some or all the general indicators for disease progression. If 3 or more of these indicators are present, it may be time to refer to hospice.

Clinical Status

Recurrent or intractable serious infections (i.e. pneumonia, sepsis or pyelonephritis)
Significant weight loss of at least 10% body weight in the past 6 months (Learn about Body Mass Index here)
- Weight loss cannot be due to reversible causes such as depression or diuretic use
- A documented decrease in anthropomorphic measurements (mid-arm circumference or abdominal girth)
- Observation of ill-fitting clothes, decreased skin turgor, increasing skin folds or other observation of weight loss without documented weight
Decreasing serum albumin or cholesterol
Dysphagia with recurring aspiration and/or inadequate oral intake documented by a decrease in food consumption

Symptoms

Dyspnea with an increase in respiratory rate
Intractable cough
Nausea or vomiting poorly responsive to treatment
Intractable diarrhea
Pain requiring more than brief increases in major analgesics

Signs

Decline in systolic blood pressure to below 90 or progressive postural hypotension
Ascites
Venous, arterial or lymphatic obstruction due to local progression or metastatic disease
Edema
Pleural / pericardial effusion
Weakness
Changes in levels of consciousness

Laboratory

Increasing pCO2 or decreasing pO2 or SaO2
Increasing calcium, creatinine or liver function studies
Increasing tumor markers (i.e., PSA or CEA)
Progressively decreasing or increasing serum sodium or increasing serum potassium

Additional Considerations

Frequent hospitalizations, ER visits, or physician visits related to primary hospice diagnosis within the past 6 months
A decline in Karnofsky Performance Status (KPS) or Palliative Performance Score (PPS) due to disease progression
Progressive decline in Functional Assessment Staging (FAST) for dementia of at least 7A
Dependence on assistance for two or more activities of daily living (ambulation, continence, transfer, dressing, feeding, and/or bathing)
Progressive stage 3-4 pressure ulcers despite optimal care
Co-morbidities—although not the primary hospice diagnosis, but the severity of which is likely to contribute to a life expectancy of 6 months or less
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Ischemic heart disease
- Diabetes mellitus
- Neurological disease (Parkinson’s, CVA, ALS, MS)
- Renal failure
- Liver disease
- Neoplasia
- Dementia
- Acquired Immune Deficiency Syndrome / HIV
- Refractory severe autoimmune disease (i.e. Lupus or Rheumatoid Arthritis)

Menu