Background St Gemma’s Hospice mean length of stay (LOS) is fourteen days, with a range from one to 104 days in 2018. Discussions regarding possible discharge from the hospice are initiated with patients if appropriate. Understanding some of the reasons why some patients have a longer LOS may assist multi-disciplinary team (MDT) decision making with a patient and their family, and potentially facilitate re-direction of hospice resources.
Methods SystmOne database identified patients whose LOS exceeded 30 days, over a one year period. Consultant combined review of SystmOne and paper hospice notes was conducted to draw themes and collate available numerical data, such as modified Barthel score and Australia-modified Karnofsky Performance Scale (AKPS).
Results 33 patient notes were reviewed. Five patients LOS greater than 70 days, 15 patients 42–69 days and 13 patients 31–41 days. 20/33 (60%) patients died during their admission. Of these 20, 14 patients had discharge planning commenced and then later stopped. The patient lived alone, with a dependent or there was presence of significant carer strain in 24/33 cases (73%).15 patients (45%) had a Barthel score of less than 20 and an AKPS of 40% or less. Complex symptoms or a variable clinical condition was felt to be contributory in only 4 cases. In 18/33 (55%), patient or family expressed a wish to remain in the hospice, rather than be discharged. Other factors included delays in funding or waiting for care packages or care home placements.
Conclusions There are several shared factors within the cohort of patients with a LOS greater than 30 days. Commencing discharge planning, is not always the patient’s preferred choice, involves several MDT members and occurred in 82%; however only 39% patients were discharged. A subsequent prospective service evaluation will now aim to assess the impact of each of these factors.
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