A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence

Ros Taylor,Angela Garcia-Perez,Robert Davies,Claire Hawksworth,Kate Heaps,Wei Gao,Liz Searle,Bee Wee,Jonathan Ellis,Giles Colclough,Steven Walker

doi:10.1186/s12904-020-0526-2

Abstract

BackgroundHospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days.MethodsPart 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category.ResultsA total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed.ConclusionsA wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent.Trial registrationN/A

Highlights

Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive
Part 1 A total of 1252 abstracts were reviewed by one author, resulting in the identification of ten categories of initiatives grouped under three broad headings (Fig. 1, Table 1): 1;‘Facilitating entry into the hospice and community care system’ [27], 2a-2 g; ‘Preventing admission’ [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74] and 3a&3b; ‘Facilitating discharge’ (Table 1) [56, 66, 72, 75,76,77,78]
2b; palliative care support in the community We identified 18 studies that included a focus on the impact of palliative care support in the community on hospital utilisation (Table 3)

Summary

Introduction

Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. Being in a hospital bed during the last weeks of life when they have no medical need or desire to be there is distressing and expensive [1,2,3]. While there may be mitigating circumstances, e.g. providing respite care, such inappropriate or non-beneficial use of resources may be regarded as a failure of the system [4,5,6] This problem is likely to intensify as the number of people dying increases along with their age at death [7].

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Discussion

Conclusion