Background In the Bristol region, 41% of patients die in hospital (2021), despite only 3% wishing to die in this setting. Continuing Health Care Fast Track (CHCFT) provides National Health Service funding to support rapidly deteriorating patients to die outside hospital.
Methods A mixed-methods service evaluation: case-note review of patients with CHCFT referral (March 1st to April 31st 2021) and semi-structured interviews (n=13) with CHCFT discharge staff (nurses, junior doctors, specialist palliative care (SPC) nurses, occupational therapists and hospital discharge team [HDT] (2022)). Key time intervals were calculated (e.g., CHCFT referral to death). Medians, means, ranges and percentages are presented. Semi-structured interviews, conducted using a topic guide, were audio-recorded, transcribed, coded by two health professionals independently and inductive data grouped by higher themes.
Results Of 72 patients referred to the HDT for CHCFT funding, 92% were known to SPC, with a median of four days from admission to SPC referral. Twenty-seven CHCFT patients (37.5%) died in hospital; 30 (41.6%) were discharged with CHCFT funding (14 (19.4%) own home and 16 (22.2%) nursing home), and 15 (20.9%) were discharged without CHCFT.
There was a median of 14.5 days from CHCFT referral to discharge, with a median of 29.5 days between SPC referral and death. Forty-two patients (58.3%) died within 30 days, 50 (69.4%) within 90 days and 67 (93.1%) within 365 days of CHCFT request.
The role of the palliative care expert was commonly emphasised by participants as critical in recognising deterioration and navigating CHCFT. Overall, CHCFT was perceived as disappointingly slow. Major barriers to timely CHCFT included delayed recognition of deterioration, multiple step/duplicated paperwork, ineffective inter-professional communication and insufficient community staffing.
Conclusion Early hospital palliative care assessment with multidisciplinary input is critical to improve timely recognition of dying and discharge. The duration to CHCFT discharge negatively impacts patients and staff.
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