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Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit
  1. Geriatric Medicine Research Collaborative
    1. Correspondence to Daisy Wilson, Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK; d.v.wilson{at}bham.ac.uk

    Abstract

    Objectives To determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours.

    Methods Multicentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019.

    Results Most patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11–28) vs died 28 days (IQR 18–42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5–19), died 15 days (IQR 9–33); p=0.003).

    Conclusions We demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.

    • hospital care
    • service evaluation
    • terminal care
    • transitional care

    Data availability statement

    Data are available on reasonable request. Data are available from the corresponding author on reasonable request.

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    Data availability statement

    Data are available on reasonable request. Data are available from the corresponding author on reasonable request.

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    Footnotes

    • Collaborators Members of the Geriatric Medicine Research Collaborative: Marie Goujon (Cambridge University Hospitals NHS Foundation Trust); Christopher N Osuafor (Cambridge University Hospitals NHS Foundation Trust); Alexander Rose (Cambridge University Hospitals NHS Foundation Trust); Benjamin Jelley (Cardiff University); Amy Hilarious (Chesterfield Royal Hospital NHS Foundation Trust); Charlotte E Hubert (Chesterfield Royal Hospital NHS Foundation Trust); Darja Saprunova (Chesterfield Royal Hospital NHS Foundation Trust); Emma Ladlow (Gateshead NHS Trust); Victoria Gaunt (Gloucestershire Hospitals NHS Foundation Trust); Melanie Dani (Imperial College Healthcare NHS Trust); Mary Ni Lochlainn (King’s College London); Chee Soo (Maidstone and Tunbridge Wells NHS Trust); Sarah Richardson (Newcastle University); Isobel Sleeman (NHS Grampian); Hannah Fairclough (North Tees and Hartlepool NHS Foundation Trust); Debbie Fraser (North Tees and Hartlepool NHS Foundation Trust); Victoria Gregg (North Tees and Hartlepool NHS Foundation Trust); Sarah Whitehouse (North Tees and Hartlepool NHS Foundation Trust); Sophie Wilcox (North Tees and Hartlepool NHS Foundation Trust); Mustafa Alsahab (Oxford University Hospitals NHS Trust); Abi McGinley (Poole Hospital NHS Foundation Trust); Ghayth Sandouka (Poole Hospital NHS Foundation Trust); Alexandra Timperley (Queens Hospital Burton); Ruth H Willott (Queens Medical Centre, Nottingham); Katherine Patterson (Queen's University Belfast); Jennifer Pigott (Royal Free London NHS Foundation Trust); Asma Khan (Sandwell and West Birmingham NHS Trust); Adam Seed (Southport and Ormskirk Hospital NHS Trust); Anthony Grubb (The Royal Wolverhampton NHS Trust); Elizabeth AM Holmes (The Royal Wolverhampton NHS Trust); Sureena Janagal (The Royal Wolverhampton NHS Trust); Natalie McNeela (The Royal Wolverhampton NHS Trust); Shailesh Nakeshree (The Royal Wolverhampton NHS Trust); Philip Thomas (The Royal Wolverhampton NHS Trust); Tarunya Vedutla (The Royal Wolverhampton NHS Trust); Micaela F Forster (University Hospital Southampton NHS Foundation Trust); Hannah Currie (University Hospitals Birmingham NHS Foundation Trust); Holly Jacques (University Hospitals Birmingham NHS Foundation Trust); Katy Madden (University Hospitals Birmingham NHS Foundation Trust); Philippa Nicolson (University Hospitals Birmingham NHS Foundation Trust); Shalini G Rajcoomar (University Hospitals Birmingham NHS Foundation Trust); Jane Moreland (University Hospitals of Derby and Burton); Lizzie Moriarty (University Hospitals of Derby and Burton); Laura Magill (University of Birmingham); Lauren McCluskey (University of Birmingham); Hannah Moorey (University of Birmingham); Rita Perry (University of Birmingham); Michala Pettitt (University of Birmingham); Thomas Pinkney (University of Birmingham); Carly Welch (University of Birmingham); Daisy Wilson (University of Birmingham); Grace ME Pearson (University of Bristol); Kelli Torsney (University of Cambridge); Jane Masoli (University of Exeter); Lindsay Ronan (University of Exeter); Oliver Todd (University of Leeds); Joanne Taylor (University of Manchester); Natalie Cox (University of Southampton).

    • Contributors All authors significantly contributed towards the design, data collection, analysis or interpretation of the data. All authors reviewed and agreed the final submitted version.

    • Funding This study received support for project delivery from the Birmingham Centre for Observational and Prospective Studies (BiCOPS) via core funding from the National Institute for Health Research (NIHR) Clinical Research Network West Midlands allocated to help support new research collaboratives.

    • Disclaimer The views expressed in this manuscript are those of the authors are not the NIHR, National Health Service, or Department of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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