Background The average hospice inpatient stay is 15 days . Admissions can extend beyond this for a variety of reasons. We aimed to 1) measure how frequently length of stay (LoS) significantly exceeded this average at Marie Curie Hospice Newcastle, deemed internally as 25 days or longer, and 2) identify factors common to LoS. LoS is relevant to the limited, intensive resource a hospice provides, where a focus is on symptom control and end of life care.
Methods Hospice inpatients admitted for 25 days or more over a nine-month period (March-December 2019) were identified using SystmOne. Reasons for referral, discharge destinations, Phase of Illness (PoI) and Australian Karnofsky performance scores (AKPS) were recorded, and notes were reviewed to identify contributing factors to LoS.
Results Of 181 patients admitted over the 9-month period, 53 patients (29%) were admitted for 25 days or longer. The median duration of stay was 35 days. Referral reason was multifactorial including symptom control, end of life care, and social breakdown. PoI on admission was unstable (23) and deteriorating (30). AKPS during the admission deteriorated (36), remained static (11) or improved (6).
28 patients died during admission and 25 patients were discharged; the majority (88%) to a nursing or care home. The four most common themes contributing to prolonged stays were complex symptoms (28), gradual deterioration (23), acute medical deterioration (21) and awaiting input from other clinical specialties (14).
Conclusions A prolonged inpatient stay was unavoidable for most patients and related to the underlying patient condition, including complex symptom management and variable disease trajectories. This perhaps highlights the complexities and management challenges with this patient cohort. The hospice has implemented changes to reduce LoS including targets for completing fast-track applications, arranging discharge planning meetings, multi-disciplinary team discharge discussions and the documentation of preferred places.
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