End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study

Maria C De Korte-Verhoef,Luc Deliens,Anneke L Francke,Bart Pm Schweitzer,Bregje D Onwuteaka-Philipsen,H Roeline W Pasman

doi:10.1186/1471-2296-13-89

Abstract

BackgroundMany patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called.MethodsA retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006) in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands). All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life.ResultsIn all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1), cardiovascular problems (OR 8,3), digestive problems (OR 2,5) and endocrine, metabolic and nutritional (EMN) problems (OR 2,5) had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2) and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4) had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%), EMN (19%) and respiratory (17%) problems.ConclusionWhilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.

Highlights

Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital
The aim of our study was to explore hospital referrals of palliative care patients for whom an out-of-hours General practitioners (GPs) was called, in recognition of the fact that hospital transfers at the end of life can be undesirable for patients and their families and that the out-of-hours service might be a critical period for these referrals
Patient characteristics In total, 13% of all palliative care patients for whom an out-of-hours GP co-operative was called were referred to hospital

Summary

Introduction

Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. Many patients are transferred between care settings during the final phase of life [1,2,3,4]. In the final months of life, the most frequent trajectory of patients who die a non-sudden death is from home to hospital. The proportion following this trajectory ranges from 36 to 40% in the final three months of life in the Netherlands and Belgium to 68% in the final six months of life in Canada. Some end-of-life hospital transfers are necessary and could benefit the patient, most patients prefer to receive care and die at home, and most families evaluate staying at home as a desirable palliative pathway [13,14,15]

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