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Background: There is clear evidence that the full range of services required to support people dying at home are far from being implemented, either in England or elsewhere. No studies to date have attempted to identify the proportion of hospital admissions that could have been avoided amongst patients with palliative care needs, given existing and current local services. This study aimed to examine the extent of potentially avoidable admissions amongst hospital patients with palliative care needs. Methods: A cross sectional survey of palliative care needs was undertaken in two acute hospitals in England. Appropriateness of admission was assessed by two Palliative Medicine Consultants using the following data collected from case notes: reasons for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; specialist palliative care involvement; and evidence of cognitive impairment. Results: A total of 1359 inpatients were present in the two hospitals at the time of the census. Of the 654 consenting patients/consultees, complete case note data were collected for 580 patients; the analysis in this paper relates to these 580 patients. Amongst 208 patients meeting diagnostic and prognostic criteria for palliative care need in two acute settings in England, only 6.7% were identified as 'potentially avoidable' hospitalisations. These patients had a median age of 84. Half of the patients lived in residential or nursing homes and it was concluded that most could have received care in this setting in place of hospital. Conclusion: Our findings challenge assumptions that, within the existing configuration of palliative and end of life health and social care services, patients with palliative care needs experience a high level of potentially avoidable hospitalisations. [ABSTRACT FROM AUTHOR]

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Background A prospective bed utilisation census of acute London hospitals using an established Day of Care Survey (DoCS), which quantified adult patients not meeting criteria for in-hospital care. Methods Twenty-three hospitals were surveyed over two weeks in October/ November 2017 using supervised trained hospital staff. Pairs of staff visited wards, reviewed all patients and identified those not meeting inpatient care criteria, recording reasons for delay. Patient demographics, length of stay (LOS), ward specialty and delay reasons were collected. Results Overall – In total, 8,656 in-patients were studied (overall occupancy 96%, range 82- 117%): 800 definite discharges were excluded, leaving 7,856 patients for analysis; seven hospitals had ≥100% occupancy; 1,919/7,856 patients (24%, range 12–43%) did not meet criteria; 56% of patients were over 70 years; five hospitals had higher number of patients <70yo. 56% patients had LOS 0≤7days. Delayed patients – Number of delayed patients increased with age, but three hospitals had more patients <70yo; 53% had LOS≤14 days and 47% LOS>14 days; 13 hospitals had greater/equal number of patients in ≤14 days LOS. For delayed patients in ≤14 days group, most were within seven days of admission (627 ≤7days, 393 8-14 days). In total 34% (range 11-54%) of delays were related to acute hospital reasons (AHR) and 61% (range 46-83%) to wider system reasons (WSR). Eight common themes accounted for 67% of recorded reasons and were equally split between AHR and WSR. Conclusion Data showed high occupancy levels with insufficient discharges. This study suggests policies selecting age and/or LOS alone as cut offs to tackle delays in care may miss a large proportion of patients requiring more timely interventions. Adopting a proactive thematic approach to improvement using the top eight delay reasons provides an obvious opportunity to reduce delays while noting the inter site variation. All metrics analysed emphasized the need for informed local data to help support local change. [ABSTRACT FROM AUTHOR]

The article discusses a survey of palliative care need undertaken in two Great Britain hospitals to explore the extent of palliative care need. It also explores the agreement between medical professionals, nursing professionals and Gold Standards Framework(GSF) in the identification of such patients. According to GSF, over a third of hospital in-patients meet the criteria to palliative care need but consensus in identification of patients was poor.