Background Hospice at Home (H@H) services aim to provide at-home care whilst dying, but these services are not universal and although studies have examined whether such services can prevent acute hospital admission, it is unclear whether they can prevent emergency hospice admissions (Buck, Webb, Moth et al., 2018; Ward, Graham & Sixsmith, 2017).
Aim To investigate whether the introduction of a H@H service would reduce emergency hospice admissions, by analysing the needs of patients admitted as an emergency to a hospice inpatient unit.
Method All patients admitted as an emergency to this hospice, which does not currently offer a H@H service, are reviewed by the multi-disciplinary team at Mortality and Morbidity (M and M) meetings. The data from this evaluation was collected between September 2016 and August 2017.
Results 190 emergency admissions took place during the above period. 93 patients (48.9%) were admitted for complex symptom control, 52 patients (27.4%) were admitted for end of life care, and 27 (14.2%) were admitted for both complex symptom control and end of life care. Eleven patients (5.8%) were admitted for multiple reasons including complex symptom control, end of life care, complex social situation and psychological distress. Seven patients (3.7%) were admitted because of social crisis. At the M and M review it was agreed that a H@H service would not have prevented 122 admissions (64.2%) but may have prevented 58 admissions (30.5%). In 10 cases (5.3%) it was unclear if H@H could have prevented admission.
Conclusion Most emergency admissions were for symptom control or multiple reasons, not end of life care alone; this may explain why only 30.5% of admissions could have been prevented with a H@H service. Patients choosing the hospice as their preferred place of death, or who were not imminently dying, will also affect the number of preventable admissions. This information on the needs of patients requiring emergency admission may help in the future development of a H@H service.
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