Abstract
BackgroundClinicians in acute hospitals make important discharge decisions that require them to estimate patients’ life expectancies. This is a particularly challenging task when it comes to older palliative care patients, even for experienced clinicians. AimTo identify factors that predict palliative care patients’ survival to discharge from hospital to residential aged care and examine the accuracy of survival predictions of two prognostic tools (Palliative Prognostic Score and Palliative Prognostic Index). MethodsRetrospective file audit of palliative care inpatients referred for residential aged care placement over a 2-year period in an acute hospital in Melbourne, Australia. Files were excluded when patients had died or been discharged home before being reviewed by the hospital's assessment team. FindingsOverall, 44% of the 71 palliative care patients referred for residential aged care placement died before being discharged from hospital. Significant predictors of survival to discharge were nonmalignant diagnoses, higher performance status, and favourable prognoses according to the Palliative Prognostic Index. The least favourable survival category of the modified Palliative Prognostic Score predicted inpatient death with low sensitivity but high specificity. DiscussionMany palliative care patients are commencing upon the taxing residential aged care placement pathway with questionable benefits to them, their families, and the healthcare system. The low rate of patients surviving to discharge may reflect gaps in the recognition of dying, amongst other system-specific challenges. ConclusionPrognostic tools can feasibly be completed with routinely collected hospital data and their use is indicated to support clinical decision-making and inform transfer decisions in acute settings. Such decisions can rely on the high specificity of the least favourable survival category of the modified Palliative Prognostic Score, which yields fewer false-negatives that would unnecessarily stretch patients’ length of stay. Equally, a favourable prognosis according to the Palliative Prognostic Index can reassure assessment teams, patients and families that a transfer is likely to be appropriate. For those patients who fall between these two categories, decisions can be supplemented by other factors shown to predict survival to discharge, including malignancy, reduced oral intake, anorexia, and a poor Karnofsky Performance Index. The need for subacute palliative care options with timely transfer processes warrants further investigation.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have