Ros Taylor1, Jonathan Ellis1, Wei Gao2, Liz Searle3, Kate Heaps4, Robert Davies5,6, Claire Hawksworth5, Angela Garcia-Perez5, Giles Colclough7, Steven Walker8,9, Bee Wee10,11. 1. Hospice UK, London, UK. 2. Cicely Saunders Institute, London, UK. 3. Keech Hospice Care, Luton, UK. 4. Greenwich & Bexley Hospice, London, UK. 5. Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK. 6. Stgilesmedical GmbH, Berlin, Germany. 7. McKinsey & Company, London, UK. 8. Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK. steven.walker@stgmed.com. 9. Stgilesmedical GmbH, Berlin, Germany. steven.walker@stgmed.com. 10. Harris Manchester College, University of Oxford, Oxford, UK. 11. Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Abstract
BACKGROUND: Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. METHODS: Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. RESULTS: A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. CONCLUSIONS: A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. TRIAL REGISTRATION: N/A.
BACKGROUND: Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. METHODS: Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. RESULTS: A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. CONCLUSIONS: A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. TRIAL REGISTRATION: N/A.
Entities:
Keywords:
Home care; Hospital care; Nursing home care; Palliative care; Service evaluation; Supportive care
Authors: Katharina van Baal; Sophie Schrader; Nils Schneider; Birgitt Wiese; Jona Theodor Stahmeyer; Sveja Eberhard; Siegfried Geyer; Stephanie Stiel; Kambiz Afshar Journal: BMC Palliat Care Date: 2020-12-08 Impact factor: 3.234