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

Robinson, Jackie; Boyd, Michal; O’Callaghan, Anne; Laking, George; Frey, Rosemary; Raphael, Deborah; Snow, Barry; Gott, Merryn

doi:10.1136/bmjspcare-2014-000724

Cited by 15 publications

(11 citation statements)

References 29 publications

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“…Significant here is to discover, and act on patient and family preferences as opposed to using place of death as a key indicator of quality of end of life care [5,63]. Robinson et al [64] emphasise that end of life decision making can be a complex affair and it can be particularly difficult for patients to exercise autonomy in the face of an uncertain and limited future [64]. A co-design approach to policy development in palliative care is proposed to increase the match between services and patient needs and wishes [65].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

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Section: Discussionmentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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“…Indeed differing approaches have been adopted in the literature. For example, a study by Robinson et al [ 44 ] defined a potentially avoidable admission as one that occurred as a result of a predictable deterioration in the patient’s condition which could have been managed by community providers. In contrast, a study by Abel et al [ 45 ] considered a hospital admission to be avoidable if the patient could have stayed at home if services as described in England’s End of Life Care Strategy were available.…”

Section: Discussionmentioning

confidence: 99%

“…However, findings from a recent integrative review showed that, largely due to inadequacies in study design, what is known about patient and family experiences of palliative care in a hospital setting is limited to discrete aspects of care [ 47 ]. Moreover, a study published subsequent to the review found that patients with palliative care needs experience a range of benefits associated with being in hospital that extend beyond the treatment they receive and almost all participants expressed a preference to be in hospital during a period of acute illness [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The ‘problematisation’ of palliative care in hospital: an exploratory review of international palliative care policy in five countries

et al. 2016

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BackgroundGovernment policy is a fundamental component of initiating change to improve the provision of palliative care at a national level. The World Health Organisation’s recognition of palliative care as a basic human right has seen many countries worldwide develop national policy in palliative and end of life care. There is increasing debate about what form comprehensive palliative care services should take, particularly in relation to the balance between acute and community based services. It is therefore timely to review how national policy positions the current and future role of the acute hospital in palliative care provision. The aim of this exploratory review is to identify the role envisaged for the acute hospital in palliative and end of life care provision in five countries with an ‘advanced’ level of integration.MethodCountries were identified using the Global Atlas of Palliative Care. Policies were accessed through internet searching of government websites between October and December 2014. Using a process of thematic analysis key themes related to palliative care in hospital were identified.ResultsPolicies from Switzerland, England, Singapore, Australia and Ireland were analysed for recurring themes. Three themes were identified: preferences for place of care and place of death outside the hospital setting, unnecessary or avoidable hospital admissions, and quality of care in hospital. No policy focused upon exploring how palliative care could be improved in the hospital setting or indeed what role the hospital may have in the provision of palliative care.ConclusionsPalliative care policy in five countries with ‘advanced’ levels of palliative care integration focuses on solving the ‘problems’ associated with hospital as a place of palliative care and death. No positive role for hospitals in palliative care provision is envisaged. Given the rapidly increasing population of people requiring palliative care, and emerging evidence that patients themselves report benefits of hospital admissions, this area requires further investigation. In particular, a co-design approach to policy development is needed to ensure that services match the needs and wants of patients and families.

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“…These factors combined with limited training in palliative care may lead to some decisions to transfer patients who could have been successfully treated at home. One study found nearly a quarter of admissions of patients with palliative care needs were potentially avoidable 7. These admissions are also expensive: potentially avoidable admissions of people in the last year of life cost two hospitals in the North of England £5.9 million per year 8…”

Section: Discussionmentioning

confidence: 99%

Hospice advice and rapid response service for ambulance clinicians

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Tipping

Anderson

et al. 2020

BMJ Support Palliat Care

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ObjectivePatients in the last year of life experience medical emergencies which may lead to an emergency attendance by ambulance clinicians and some patients having a transfer to hospital even when this is unwanted by patients, carers or professionals. Here we report the patient characteristics and outcomes of a 24-hour hospice nursing telephone advice service to support an ambulance service.MethodAn evaluation of the outcomes of ambulance calls to a nursing telephone advice service for people living in northwest London, UK, attended at home during a 6-month period by the London Ambulance Service, whose clinicians then sought advice from the hospice’s 24 hours’ telephone line.ResultsForty-five attendances of 44 acutely ill people with palliative care needs resulted in a telephone call. Thirteen patients (30%) were male and the median age was over 80 years. Thirty-two attendances (71%) were managed without a transfer to hospital, with telephone advice from the hospice and in some cases arrangements for another clinician to visit. Seven attendances (16%) resulted in a transfer to hospital, of which at least five led to an admission. Six attendances (13%) resulted in a notification of the patient’s death.ConclusionsThis preliminary study shows the feasibility, outcomes and acceptability of telephone advice to support ambulance clinicians attending patients with palliative care needs. The service was associated with low rates of subsequent transfer to hospital. Further controlled research is needed to assess the clinical and cost-effectiveness of the service.

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

Cited by 15 publications

References 29 publications

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

The ‘problematisation’ of palliative care in hospital: an exploratory review of international palliative care policy in five countries

Hospice advice and rapid response service for ambulance clinicians

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