Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit

Abstract

Objectives: To determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours.

Methods: Multicentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019.

Results: Most patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11-28) vs died 28 days (IQR 18-42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5-19), died 15 days (IQR 9-33); p=0.003).

Conclusions: We demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.

Keywords: hospital care; service evaluation; terminal care; transitional care.