Abstract
BackgroundTransitions in the location of care and in who provides such care can be extremely stressful for individuals facing death and for those close to them. The objective of this study was to describe the distribution of transitions in care experienced by palliative care patients following admission to a comprehensive palliative care program (PCP). A better understanding of these transitions may aid in reducing unnecessary change, help predict care needs, enhance transitions that improve quality of life, guide health care system communication links and maximize the cost-effective utilization of different care settings and providers.MethodsTransition and demographic information pertaining to all patients registered in the PCP at the Queen Elizabeth II Health Sciences Centre (QEII), Halifax, Nova Scotia, Canada between January 1, 1998 and December 31, 2002 and who died on or prior to December 31, 2002 was extracted from the PCP database and examined. A transition was defined as either: (1) a change in location of where the patient was cared for by the PCP or, (2) a change in which clinical service provided care. Descriptive analysis provided frequencies and locations of transitions experienced from time of PCP admission to death and during the final two and four weeks of life, an examination of patient movement and a summary of the length of stay spent by patients at each care location.ResultsOver the five year period, 3974 adults admitted to the QEII PCP experienced a total of 5903 transitions (Mean 1.5; standard deviation 1.8; median 1). Patients with no transitions (28%) differed significantly from those who had experienced at least one transition with respect to survival time, age, location of death and diagnosis (p < 0.0001). The majority of patients were admitted to the PCP from various acute care units (66%). Although 54% of all transitions were made to the home, only 60% of these moves included care provided by PCP staff. During the last four weeks of life, 47% of patients experienced at least one transition; 36% during the final two weeks of life. Shorter stays in each location were evident when care was actively provided by the PCP.ConclusionA relatively small number of patients under the care of the PCP at the end of life, made several transitions in care setting or service provider. These particular patients need closer scrutiny to understand why such transitions take place so that clinical programs may be designed or modified to minimize the transitions themselves or the impact transitions have on patients and families.
Highlights
Transitions in the location of care and in who provides such care can be extremely stressful for individuals facing death and for those close to them
We report the proportion of transitions as death becomes imminent and describe the length of stay in each location of care or care setting
Subjects Subjects included all adult patients registered in the palliative care program (PCP) at the Queen Elizabeth II Health Services Centre (QEII) in Halifax, Nova Scotia, Canada between January 1, 1998 and December 31, 2002 with a recorded date of death on or prior to December 31, 2002
Summary
Transitions in the location of care and in who provides such care can be extremely stressful for individuals facing death and for those close to them. For those close to them, transitions in the location of care and in who provides care can be extremely stressful.[1] Such transitions include moving from home to hospital or to long-term care facilities, from ward to ward within hospitals, or in and out of care directed by particular care providers (such as specialists). The program transition information provided the date of each transition and locations the patient had been moved to or from (for example, home, an acute care facility, long-term care) as well as the clinical service providing care. The service indicator field provided a record of whether patients were 'actively' being cared for by PCP staff or whether their care had been transferred to the staff of the NSCC or family doctor (either locally or elsewhere in the province)
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