Offering older hospitalised patients the choice to die in their preferred place

Abstract

Background A significant proportion of older people state a preference to die at home. However, the vast majority of people in hospital recognised as dying subsequently die there. Objectives To identify the proportion of older people dying in hospital where the possibility of ending life elsewhere was explored. To identify factors that could support hospital staff to enable patients' wishes to be met. Methods Retrospective case-note review of 100 older patients (>75 years) who died during 2009 in an English Hospital.

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

“…Assessments of potentially avoidable admissions were made by Palliative Medicine consultants from the standpoint of the admitting clinician, using expert judgements based on complete case note information. This subjective approach may be open to individual bias, however in the absence of any validated protocols to identify potentially avoidable admissions [17,18], context specific expert judgement was deemed the most appropriate way to classify admissions.…”

“…Consultants reviewed the notes from the hospital they worked at, as in-depth knowledge of local service provision, configuration and extent of health and social care services for this patient group was considered critical to inform decision- making. In the absence of any validated protocols to identify potentially avoidable admissions [17,18], context specific expert judgement was deemed the most appropriate way to classify admissions. Appropriateness of admission was assessed using the following data collected from case notes: reason for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; evidence of palliative care involvement; evidence of cognitive impairment.…”

‘Rapid discharge’: issues for hospital‐based nurses in discharging cancer patients home to die

“…Moreover, evidence suggests that recognition of dying may be difficult until very late in the disease trajectory (Ahearn et al . , Neuberger et al . ), although more so in noncancer patients (Boland et al .…”

“…It has been suggested that patients' care goals and preferences on place of death should be addressed routinely, for instance during discussion of resuscitation status, to improve healthcare usage and enable more deaths to occur in preferred settings (Ahearn et al . , Apostol et al . ).…”

The extent and cost of potentially avoidable admissions in hospital inpatients with palliative care needs: a cross-sectional study

“…This approach has been used in a similar study in the UK to identify avoidable hospital admissions in palliative care 13. Similar approaches to examining clinical decision-making using retrospective case note data have also been used in other studies 18 19…”