What Triggers a Referral

If your patient is experiencing any of the following, please contact Hospice & Community Care’s Sunflower Pediatric Team at (844) 422-4031 to discuss whether hospice, or hospice with concurrent care, may be appropriate.

 General Advanced Illness:
Presence of a chronic, complex or life-threatening illness/condition and one or more of the following:

  • Conflicts regarding use of medical nutrition/hydration in cognitively impaired, seriously ill or dying patients
  • New diagnosis of life-limiting or life-threatening disease
  • Three or more hospitalizations within six months
  • Difficult pain or symptom management
  • Patient, family or physician uncertainty regarding prognosis
  • Family with limited social supports
  • AND (Allow Natural Death)/DNR order or other ethical conflicts
  • Complex care coordination and/or homegoing needs
  • Prolonged hospitalization for more than three weeks
  • Need for support of Hospice Interdisciplinary Team

Presence of malignant disease with any one of the following:

  • Progressive metastatic cancer
  • Bone marrow/stem cell transplant
  • Diffuse intrinsic pontine glioma
  • Stage IV neuroblastoma
  • Relapsed malignant disease following stem cell/bone marrow transplant
  • Any newly diagnosed malignant disease in the setting of poor functional status and frailty
  • Any relapsed malignant disease
  • Metastatic solid tumors

Pulmonary Criteria:
Presence of compromised pulmonary status with any one of the following:

  • Patients with CF with FEV1 <30%
  • Patients with CF with vent dependence or those ineligible for lung transplant
  • Bronchiolitis obliterans
  • Patients with CF with multiple hospitalizations
  • Central hypoventilation syndromes
  • Patients who are chronically ventilator dependent

Genetic Criteria
Presence of any of the following:

  • Trisomy 18, 13, 15
  • Asphyxiating thoracic dystrophy
  • Severe forms of osteogenesis imperfecta (type 3 or 4)
  • Potter Syndrome
  • Epidermolysis Bullosa
  • Rett’s Syndrome
  • Other rare chromosomal anomalies with known poor neurologic prognosis

Neonatal Criteria
Presence of one of the following:

  • Extreme prematurity with concomitant severe BPD, Grade IV IVH, PVL, etc.
  • Severe birth asphyxia
  • Hypoxic ischemic encephalopathy (moderate to severe)
  • VLBW infants

Cardiac Criteria
Presence of one of the following:

  • Single ventricle cardiac physiology
  • Severe pulmonary hypertension
  • Down syndrome with significant cardiac abnormality
  • Ebstein’s anomaly
  • Eisenmanger’s syndrome
  • Cardiomyopathy: hypertrophic or severe dilated
  • Pulmonary atresia (especially if associated with hypoplastic pulmonary arteries)
  • Ongoing discussion of cardiac transplant
  • Combination of cardiac diagnosis with underlying neurologic/chromosomal diagnosis
  • Complex congenital heart disease
  • ECMO candidate
  • Severe myocarditis