1. A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence
- Author
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Robert W. Davies, Steven Walker, Jonathan Ellis, Angela Garcia-Perez, Claire Hawksworth, Kate Heaps, Bee Wee, Liz Searle, Ros Taylor, Giles Colclough, and Wei Gao
- Subjects
Telemedicine ,Palliative care ,Hospital bed ,Pain medicine ,lcsh:Special situations and conditions ,Bed days ,Home care ,03 medical and health sciences ,0302 clinical medicine ,Patient Admission ,Nursing ,Medicine ,Humans ,Home education ,030212 general & internal medicine ,Nursing home care ,Quality of Health Care ,Service (business) ,Terminal Care ,Hospital care ,business.industry ,lcsh:RC952-1245 ,General Medicine ,Length of Stay ,Integrated care ,Service evaluation ,Hospitalization ,030220 oncology & carcinogenesis ,business ,Supportive care ,Research Article - Abstract
Background Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. Trial registration N/A
- Published
- 2020