Open Access Research article

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

Merryn Gott1, Clare Gardiner2, Christine Ingleton3, Mark Cobb4, Bill Noble5, Michael I Bennett6 and Jane Seymour7*

Author Affiliations

1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Level 2, Building 505, 85 Park Road, Grafton, Auckland, New Zealand

2 School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK

3 School of Nursing & Midwifery, The University of Sheffield, Barber House, 387 Glossop Road, Sheffield, S10 2HQ, UK

4 Sheffield Teaching Hospitals NHS Foundation Trust, 14 Claremont Crescent, Sheffield, S10 2TA, UK

5 St Luke’s Hospice, Little Common Lane, Sheffield, S11 9NE, UK

6 Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9LJ, UK

7 School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2HA, UK

For all author emails, please log on.

BMC Palliative Care 2013, 12:9  doi:10.1186/1472-684X-12-9

Published: 18 February 2013

Abstract

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.

Keywords:
Palliative care needs; End of life; Avoidable admissions; Inappropriate admissions; Survey; Acute hospital