The extended care unit: A feasible economic solution for longer-term palliative inpatients.

Abstract

143 Background: Many inpatient palliative care units (PCUs) in Australia require patients who cannot go home, but remain stable after 2 weeks, to be discharged to nursing homes (NHs). This involves moving between 5 locations (home, acute hospital, PCU, NH transition bed, NH), in the final weeks of life. We propose an “Extended Care Unit” (ECU) to avoid unnecessary moves for such patients. This study aimed to investigate the feasibility of the proposed ECU, including identifying demand, admission criteria, length of stay, and hospital costs. Methods: Using a retrospective, observational design, we censored all inpatients on a single day from the largest tertiary referral centre in the state. 475 files were reviewed. ECU admission criteria used were: prognosis < 90 days, unable to return home, and NH referral process commenced. Two predictive mortality scores were calculated. Total cost was calculated based on average bed cost over 12 months. ECU bed costs were based subacute aged care bed costings. Results: Fifteen (3%) patients met ECU admission criteria. 80% (n = 12) died within 90 days. 60% were transferred between ≥ 4 places. After fulfilling ECU admission criteria, a further 279 acute and PCU bed days were used. If an ECU were available, hospitals would save $207.70 per patient per bed day. Conclusions: The ECU model is a feasible economic solution for this demographic of patients whose needs are currently poorly met. We provide evidence of clear demand, with significant cost savings. Effective admission criteria to identify suitable patients for the ECU are also proposed.