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. 2013 Feb 18:12:9.
doi: 10.1186/1472-684X-12-9.

What is the extent of potentially avoidable admissions amongst hospital inpatients with palliative care needs?

Merryn Gott  1 , Clare Gardiner, Christine Ingleton, Mark Cobb, Bill Noble, Michael I Bennett, Jane Seymour
Affiliations

What is the extent of potentially avoidable admissions amongst hospital inpatients with palliative care needs?

Merryn Gott et al. BMC Palliat Care. .

Abstract

Background: There is clear evidence that the full range of services required to support people dying at home are far from being implemented, either in England or elsewhere. No studies to date have attempted to identify the proportion of hospital admissions that could have been avoided amongst patients with palliative care needs, given existing and current local services. This study aimed to examine the extent of potentially avoidable admissions amongst hospital patients with palliative care needs.

Methods: A cross sectional survey of palliative care needs was undertaken in two acute hospitals in England. Appropriateness of admission was assessed by two Palliative Medicine Consultants using the following data collected from case notes: reasons for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; specialist palliative care involvement; and evidence of cognitive impairment.

Results: A total of 1359 inpatients were present in the two hospitals at the time of the census. Of the 654 consenting patients/consultees, complete case note data were collected for 580 patients; the analysis in this paper relates to these 580 patients. Amongst 208 patients meeting diagnostic and prognostic criteria for palliative care need in two acute settings in England, only 6.7% were identified as 'potentially avoidable' hospitalisations. These patients had a median age of 84. Half of the patients lived in residential or nursing homes and it was concluded that most could have received care in this setting in place of hospital.

Conclusion: Our findings challenge assumptions that, within the existing configuration of palliative and end of life health and social care services, patients with palliative care needs experience a high level of potentially avoidable hospitalisations.

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Figures

Figure 1
Figure 1
Details of recruitment for hospital in-patients at SNGH and RLI.
Figure 2
Figure 2
Total numbers of patients meeting each GSF prognostic indicator criteria (n = 208).
Figure 3
Figure 3
Numbers of patients meeting each GSF prognostic indicator, for patients whose admission was considered potentially avoidable (n = 14).
Figure 4
Figure 4
Reason for admission to hospital for potentially avoidable patients (n = 14).
See this image and copyright information in PMC

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