SHM Converge Scientific Abstract ePoster Gallery-Best Practices for Patient Repatriation at the End of Life

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This document discusses best practices for patient repatriation at the end of life, using a case from a New York City safety-net hospital. It highlights that repatriation can be a complex discharge decision for hospitalized immigrants who wish to die in their home country, requiring early planning, interdisciplinary coordination, and culturally sensitive care.<br /><br />Key recommendations include beginning repatriation discussions when there is a decline in functional status and prognosis suggests less than 1 year or 6 months to live. Planning should involve the primary team, consultants, palliative care, social work, and risk management. Other important steps include contacting embassies or consulates for funding or visa assistance, arranging medications and supplies for travel, choosing the safest and least disruptive transport time, and considering whether ambulance transport may draw unnecessary attention. The presentation also notes practical issues such as risk of boarding denial, seating options, accompaniment by an escort, possible mid-flight death, coordination with family and transport in the home country, and repatriation of remains if needed.<br /><br />The clinical case involves a 70-year-old woman with stage IV cholangiocarcinoma and multiple severe comorbidities, including heart failure, CKD, PE/DVT, HBV, sepsis, renal failure, arrhythmia, and shock. She was born in Gambia, spoke Soninke, lived in NYC with her son and daughter-in-law, and had many family members in Gambia. Her family strongly wished to bring her home to honor her wishes. Prognostic tools such as PPS and ECOG were used to estimate survival, which suggested only weeks to a month remaining.<br /><br />The main conclusion is that hospitalists play a crucial role in coordinating safe, goal-concordant repatriation for seriously ill patients.

Asset Subtitle

Luyi Kathy Zhang

Meta Tag

Author List Luyi Kathy Zhang

Category Clinical Vignettes

Concept Back Transfer

Concept End-of-Life Care

Concept Functional Status

Concept Prognosis

Concept Interdisciplinary Team

Distinguished Non-Finalist

Presenter Organization Bellevue Medical Center/Nyu Langone

Presenting Author Luyi Kathy Zhang

Track Adult

Keywords

patient repatriation

end-of-life care

immigrant patients

palliative care

interdisciplinary coordination

culturally sensitive care

hospital discharge planning

prognosis

medical transport

safety-net hospital

Back Transfer

End-of-Life Care

Functional Status

Prognosis

Interdisciplinary Team