Responding 24/7: an evaluation of urgent admission requests to the hospice

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Abstract

Introduction

Provision of 24/7 palliative care is a national priority. Hospices endeavour to respond to the palliative care needs of patients and families timeously, though resources are limited.

Aim

This study aimed to evaluate urgent admission requests to the hospice, via the on-call doctor.

Methods

Data on time of call; reason for and source of referral (GPs, community nurses, patients and families); whether the patient was known to the hospice; and details about the decision to admit were collected prospectively over three months.

Results

There were 131 admissions to the hospice. Fifty-seven requests for urgent admission were recorded, the majority for symptom control (n = 34). Thirty-eight (67%) were considered appropriate requests - defined as patients with specialist palliative care needs that could not be met elsewhere. Twenty (53%) appropriate requests were admitted the same day, and 10 (26%) the following. Eight patients (21%) were not admitted because of bed or staff shortages; four were directed to the acute sector as an alternative place of care.

Results

Nineteen (33%) requests were not accepted, mostly because they were considered clinically inappropriate. However, six (11%) were provided with support and advice which enabled patients to remain in their current setting.

Conclusions

There is a need for direct access to a specialist palliative care doctor as this service is frequently used. Most appropriate requests for urgent admission were admitted within one day, suggesting a responsive service. Education for healthcare professionals is needed to ensure appropriate hospice referral, enabling patients to achieve their preferred place of care.

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