Out-of-hours services and end-of-life hospital admissions: a complex intervention systematic review and narrative synthesis

Papavasiliou, Evie; Hoare, Sarah; Bowers, Ben; Kelly, Michael P.; Barclay, Stephen

doi:10.3399/bjgp.2021.0194

Cited by 11 publications

(15 citation statements)

References 49 publications

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“…A long-standing GP-patient relationship is known to reduce the use of OOH-service and hospital admissions in the general population [ 46 ]. Furthermore, it is known that continuity of care in primary care is important when organizing palliative care [ 45 , 47 ], and according to a systematic review from 2021, the lack of continuity of care is associated with end-of-life hospital admissions OOH [ 48 ]. A recent Norwegian study found that GPs find it hard to avoid OOH hospital admissions if they have not been involved in the care of the patients [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

2022

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Background Modern palliative care focuses on enabling patients to spend their remaining time at home, and dying comfortably at home, for those patients who want it. Compared to many European countries, few die at home in Norway. General practitioners’ (GPs’) involvement in palliative care may increase patients’ time at home and achievements of home death. Norwegian GPs are perceived as missing in this work. The aim of this study is to explore GPs’ experiences in palliative care regarding their involvement in this work, how they define their role, and what they think they realistically can contribute towards palliative patients. Methods We performed focus group interviews with GPs, following a semi-structured interview guide. We included four focus groups with a total of 25 GPs. Interviews were recorded and transcribed verbatim. We performed qualitative analysis on these interviews, inspired by interpretative phenomenological analysis. Results Strengths of the GP in the provision of palliative care consisted of characteristics of general practice and skills they relied on, such as general medical knowledge, being coordinator of care, and having a personal and longitudinal knowledge of the patient and a family perspective. They generally had positive attitudes but differing views about their formal role, which was described along three positions towards palliative care: the highly involved, the weakly involved, and the uninvolved GP. Conclusion GPs have evident strengths that could be important in the provision of palliative care. They rely on general medical knowledge and need specialist support. They had no consensus about their role in palliative care. Multiple factors interact in complex ways to determine how the GPs perceive their role and how involved they are in palliative care. GPs may possess skills and knowledge complementary to the specialized skills of palliative care team physicians. Specialized teams with extensive outreach activities should be aware of the potential they have for both enabling and deskilling GPs.

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Section: Discussionmentioning

confidence: 99%

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

2022

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“…Eight emergency issues were flagged as prevalent, and several minor medical issues were consistently raised. Given the need to triage for hospital admission (or render initial management) mentioned before and big role of phone-based support (at least till the next workday), customised staff training including resource aides could be produced [7,12,17]. Second, like others before [5,12], work improvement efforts around better 'in-hours' communication to reduce the need to 'clarify care plans' (17.6% of calls) and deliberate advice on procedures after death to minimise calls 'informing that patient has died' (10.5% of calls) are worth looking into [7,15,19].…”

Section: Discussionmentioning

confidence: 99%

“…After-hours palliative care support is a lifeline to patients with serious medical conditions who choose to spend more days at home rather than an institution like hospital or hospice [1][2][3][4][5][6][7][8]. Operating a 24/7 telephone helpline is fundamentally how most services render out of hours support.…”

Section: Introductionmentioning

confidence: 99%

“…Operating a 24/7 telephone helpline is fundamentally how most services render out of hours support. Resource considerations manning these helplines and its toll on designated healthcare staff have been acknowledged [9,10], but current evidence reveals little beyond different reasons for seeking urgent assistance while receiving hospice support at home [7,[11][12][13][14][15][16]. It is unclear how individual calls outside normal work hours are managed in a full suite service that also provides emergency home visits.…”

Section: Introductionmentioning

confidence: 99%

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Utilisation of after-hours telephone support in a home-based hospice service

Chong¹,

Lee²,

Yeo³

et al. 2022

BMC Palliat Care

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Background: After-hours support from hospice providers is instrumental to patients with serious illness who choose to remain at home, particularly at end of life. Utilisation of out-of-hours support has been much characterised in terms of frequency and nature of calls, but more needs to be known to inform service customisation and resource allocation to optimise care. To this end, we stratify reasons for using the after-hours helpline according to time sensitivity, and to explore disease and person factors associated with urgent calls.Method: Electronic medical records for incoming calls from external parties outside workhours within a large home hospice in Singapore were analysed inductively, to identify patterns and associations along study objectives. Individual code books for caller type and call reasons were created and tested in vivo, and later administered to extracted data. Patients that accessed the helpline were tracked for different outcomes, including hospital admissions and on-call home visits. Logistic regression modelling was performed to categorise call reasons by urgency and to identify disease and person factors associated with time sensitive calls.Results: More than 5,000 calls to the helpline were made over a two-year period (2019-2020), predominantly by family caregivers (88.4%). These were in relation to 2,303 unique patients (38.9% of total patients served). After-hours calls were made an average of 2.3 times by patients across various lengths of service. Only 11.9% of calls were deemed time sensitive or urgent, requiring home visits by on-call staff (4%) or resulting in admission to hospital (7.9%). The majority were managed by primary care teams on the next workday (65.1%) and the remainder sorted during the after-hours call itself (22.3%). Call reasons or presenting issues were classified into two groups according to urgency. Calls in the year 2020, from the younger patient, preferred place of death outside the home, and caller types other than patient or healthcare worker were significantly associated with urgent calls. Conclusion:Deeper characterisation of after-hours calls offers possibilities: service redesign for optimal resourcing and customised training for better care. Ultimately, planners, providers, and patients all stand to benefit.

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“…13 There are recurrent problems in the provision of out-of-hours care, including the challenge of co-ordinating care between different services, uncertainties around prognostication and decision-making about admission to hospital, while taking into account the capacity to care (by informal and formal carers) for the patient at home and the wishes of patient and family. 14 , 15 To date there is a lack of agreement about which models of care (and which components of these models), including out-of-hours provision, provide good quality care for patients and families near end of life. 16 …”

Section: Introductionmentioning

confidence: 99%

The most important components of out-of-hours community care for patients at the end of life: A Delphi study of healthcare professionals’ and patient and family carers’ perspectives

et al. 2022

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Background: Community services for palliative patients outside normal working hours are variable and the best evidence-based models of care have not been determined. Aim: To establish expert consensus on the most important components of out-of-hours community palliative care services. Design: Delphi study. The first round listed 68 components generated from systematic literature reviewing, focus groups with healthcare professionals and input from the project’s patient and public involvement advisory group. The components deemed ‘essential’ by over 70% of participants in the first round were refined and carried forward to a second round, asking participants to rank each on a five-point Likert scale (5 highest to 1 lowest). The consensus threshold was median of 4 to 5 and interquartile range of ⩽1. Participants: Community specialist palliative care health professionals, generalist community health professionals and patients and family carers with experience of receiving care out-of-hours at home. Results: Fifty-four participants completed round 1, and 44 round 2. Forty-five components met the threshold as most important for providing out-of-hours care, with highest consensus for: prescription, delivery and administration of medicines; district and community nurse visits; and shared electronic patient records and advance care plans. Conclusions: The Delphi method identified the most important components to provide community palliative care for patients out-of-hours, which are often provided by non-specialist palliative care professionals. The importance placed on the integration and co-ordination with specialist palliative care through shared electronic records and advance care plans demonstrates the reassurance for patients and families of being known to out-of-hours services.

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Out-of-hours services and end-of-life hospital admissions: a complex intervention systematic review and narrative synthesis

Cited by 11 publications

References 49 publications

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

Utilisation of after-hours telephone support in a home-based hospice service

The most important components of out-of-hours community care for patients at the end of life: A Delphi study of healthcare professionals’ and patient and family carers’ perspectives

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