The 2 hospice in-patient units combined have 27 in-patient beds. For every admission we document decisions about cardio-pulmonary resuscitation and transfer to acute hospital. Both units offer intra-venous treatments (blood products, bisphosphonates and antibiotics). Previously published audits1 were done in units were intravenous antibiotics were not available. This retrospective service evaluation was done in order to evaluate what happened to transferred patients and whether we can improve our practice in the future.
The authors looked at the clinical notes of all transfers to acute hospital between January 2014 and July 2015. Case finding relied on memory and documentation in admission books.
There were 16 transfer (involving 13 patients) 8 for diagnosis (fracture, MSCC, PE) 7 for treatment (electrolyte abnormality, neutropaenic sepsis and NIV initiation) and 1 for a post-surgical complication. Ten transfers happened during normal working hours and six out of usual working hours. Decisions tended to be well documented and consultants were involved in eleven cases.
In 11 instances the patient returned to the unit, 2 died in hospital, 2 were discharged home, 1 patient died 3 weeks later (location unclear) and in 12 cases the aim of the transfer was met.
Further analysis revealed that most transfer decisions were well documented. However what information was sent with the patient and criteria for return to the unit were not clear and patients lingered longer than intended in the acute hospital. We did not evaluate decisions not to transfer to hospital.
In future we aim
Not only to document suitability for transfer on admission but also review this regularly.
To document changes in clinical condition which may lead to transfer to acute hospital whether or not patient is transferred.
On transfer to communicate doctor-to-doctor with clear goals and return criteria
To liaise with hospital palliative care team.
References 1. Castanheira T, Wright BA.Survey about patients transferred from a Specialist ?Palliative Care unit to an acute hospital setting . European Journal of Palliative Care 2014;21:219–221
2. Doidge M, Perkins P.Letter to the editor.European Journal of Palliative Care2015;22(1)
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