Background St Nicholas Hospice Care covers a population of 2 85 000 across West Suffolk/South Norfolk, with a 10-bed ward and community services. This project was prompted by feedback that discharge planning was a source of distress for some patients/families, particularly if the patient died during admission. We aimed to investigate the scale of the problem and identify areas for improvement.

Method Admissions April-July 2017 inclusive were identified. Demographics and details of admission and discharge were retrieved for each patient, collated and analysed.

Results 77 admissions were identified from 73 patients (4 readmissions). 40 (52%) patients died in hospice, 35 (45%) were discharged (3% were transferred to hospital). For those dying in hospice, only 15 (37.5%) had discharge discussed at any point, though for 11 (73%) of those, discussions continued, within a week of death. Discharge discussions were much more likely to be hospice-led for those who died here (13/15; 87%), whereas patients who were discharged initiated the planning discussions 60% of the time (21/35). Rearranging, in hospice-led discharge discussions, 48% (13/27) went on to die during admission, whereas in patient-led discussions, just 9% (2/23) died, a statistically significant difference (p=0.002).

Of those discharged, 29 (83%) had a positive reaction to discussions; 6 (17%) had a neutral (accepting) reaction. For those who died in hospice having discharge discussions, reactions were 8 (53%) positive, 5 (33%) neutral and 2 (13%) negative. Families’ reactions were very similar. Of those discharged, 20 (57%) lived for over four weeks after discharge. 10 (29%) died within 2 weeks of discharge: only one had a non-positive reaction to discharge planning.

Conclusions The majority of patients do not appear to have inappropriate discharge discussions very close to a death in the hospice. Hospice-led discharge discussions more often are followed by patients dying prior to discharge – a known source of distress – than patient-led discussions are. This study therefore suggests that hospice-led discharge discussions would be a time for caution.