Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals

Abstract

The results suggest that adequate support of and a care network for palliative patients and their caregivers are crucial for continuous home-based EOLC. Timely recognition of the advanced palliative phase as well as the involvement of well-trained GPs who feel confident in palliative care, together with adequate financial support for outpatient palliative care, might diminish the frequency of transitions shortly before death.

What are the risk factors for avoidable transitions in the last year of life? A qualitative exploration of professionals’ perspectives for improving care in Germany

“…An additional demand includes consistent discharge management, a more flexible approach to data protection and the use of modern technologies, especially in hospitals. Similar to our results, the availability and accessibility of receiving community services were identified as a potential risk factor for a hospitalization also near the final stage of life [6,10,20,22,23,34]. Both overcoming curative thinking towards openness to palliative care and structural reform of the health system are needed to avoid the strong economic focus of health organizations on diagnostic and curative treatment in the LYOL.…”

“…The results of our study show that timely identification and anticipatory discussions about the current health status and care planning in the LYOL could build the foundation of efficient care provision in the context of avoidable transitions. Anticipatory discussions and interventions to deal with expected severe problems could lower the frequency of avoidable transitions as already stated in the literature [10,17,34,40]. However, if the patients are not identified, such discussions cannot be held.…”

“…Several studies found transitions increase in the last months of life [1][2][3][4][5], with most of them concerning hospitalization [1,3,4,[6][7][8]. The frequent hospital attendance at this stage of life contradicts most patients' preference for home-based care [7,9,10]. The situation is similar in a longer period of the last 12 months of life [5,6,8,11,12].…”

“…About half of them were from home to hospital, almost a quarter from hospital to home, and transitions between nursing home to hospital and hospital to hospital were less frequent [9]. Numerous transitions across healthcare settings in the last months of life are potentially avoidable [10,[13][14][15][16].…”

Hospitalisation in the last month of life and in-hospital death of nursing home residents: a cross-sectional analysis of six European countries

“…1 Older people living in nursing homes have a high level of comorbidity, frailty and complex health needs; 2 hospitalisation comes with a number of drawbacks like low satisfaction with care, rapid functional decline, low survival rates and a suboptimal quality of end-of-life care and should thus be avoided without strong clinical indication. [3][4][5][6][7] Nevertheless, in many countries hospitalisation of nursing home residents at the end of life is not infrequent and some die there, even if they would had preferred not to. [8][9][10][11][12][13] Most studies on hospitalisation of nursing home residents in the last month of life have been conducted in the USA and many focused on place of death; 14 only a few looked at associated factors, mainly limited to resident-level factors such as age or gender, and reported inconsistent results, with highly variable hospitalisation rates.…”