The impact of COVID-19 and community services on palliative care unit admissions: A retrospective cohort study

Abstract

Background Collaboration between palliative care units (PCUs) and community palliative care (CPC) services is key to providing integrated care across inpatient and outpatient settings, in response to local and global challenges. Aim To identify the effect of the COVID-19 pandemic and local CPC service changes on admissions, discharges, and patient access to a metropolitan Australian specialist PCU. Methods A retrospective cohort study of PCU admissions was performed across three six-month periods, in 2017, 2019, and 2021. Patients’ demographics and primary diagnoses were assessed for association with CPC service involvement prior to their first PCU admission. Admission characteristics including referral location, indication for admission, length of stay, palliative care phase and place of death were compared between the three time periods. Results There were 707 admissions during the studied time periods, corresponding to 589 unique patients, of whom 89% had a principle diagnosis of malignancy. Non-cancer and haematology patients were less likely to be linked with a CPC service prior to their first admission. Most admissions (51%) were arranged directly to the PCU from the community. Compared to earlier time periods, during the COVID-19 pandemic, patients had shorter admissions, were more likely to be discharged in the deteriorating or terminal phases, and had four times the odds of dying at home. Conclusion COVID-19 had significant impacts on the characteristics of PCU admissions, which has ongoing implications for CPC services. Continuous service delivery evaluation and adaptation are required to ensure equitable access to palliative care during periods of change.