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P-43 Admission avoidance – Preventing unnecessary hospital admissions in the last phase of life
  1. Ross Chirgwin
  1. St Helena Hospice, Colchester, UK


Background With the increased strain on healthcare nationally, all healthcare providers have a duty to prevent inappropriate admissions to an acute hospital (Local Government Association, 2021.). Hospices are in a unique position to support patients to remain in their preferred place of care (PPC) by utilising the skills and knowledge of the multidisciplinary team (Spencer. Int J Palliat Nurs. 2015, 21(5):245).

Aims To evaluate the role of the hospice in preventing inappropriate admissions to hospital. For the purpose of the audit, admission avoidance was defined as; preventing someone from being admitted to an acute hospital and allowing them to be supported and die within their PPC. The intervention taken place must prevent admission for at least 72 hours.

Method The audit took place within the hospice in the home multidisciplinary team over a two-week period. Clinicians informed the auditor if their intervention prevented an admission into hospital. The data was then collated and at the end of the two weeks each patient record was reviewed to confirm that the intervention prevented admission.

Results 19/19 patients reviewed were able to remain in their PPC and were prevented from being unnecessarily admitted to hospital. The hospice rapid response team prevented the most admissions, however, this was expected due to the nature of the role and 24/7 working pattern.

Common themes included:

  • Rapid assessment, prescribing and symptom control.

  • Initiating urgent care packages via the hospice virtual ward.

  • Timely advance care planning allowing informed decisions about their future care.

  • Urgent admission into the hospice or nursing home placement.

  • Joint working with the ambulance service supporting patients to remain in their PPC.

  • Provision of urgent equipment.

Conclusion The audit has provided evidence that the hospice is actively preventing admissions into the acute hospital. The interventions taken place have supported patients to remain in their PPC by providing timely person-centred care.

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