Palliative Care — Could Your Patient Have Been Managed at Home?

1992 ◽  
Vol 8 (2) ◽  
pp. 18-22 ◽  
Author(s):  
Stan Lubin
Keyword(s):  
Palliative Care ◽  
Cost Reduction ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
University Hospital ◽  
Care Hospital ◽  
Care At Home ◽  
Care Period ◽  
At Home

Palliative care, supportive care of the dying, is rapidly changing to better meet the needs of the patients and families. If palliative care is provided in the home rather than in hospital, there is a potential for improvement in the quality of life for patients and their families and a potential for cost reduction in the health care system. Our study was undertaken to determine whether or not palliative care patients admitted to University Hospital could have been cared for at home rather than in the hospital. The hospital charts of 96 palliative care patients were reviewed retrospectively. The results indicated that 61 % of these palliative care patients did not receive any palliative care at home and that 94% died in an acute care hospital setting. Only 18% lived in a setting other than their own home, and 68% had a spouse or other family member living with them at the time of their final admission. Based on the level of support in the place of residence prior to final admission and the reasons for admission, we determined that many of the patients could have been managed at home for at least some of the palliative care period if appropriate support from a home care team had been available.

Ecological Study of the Effectiveness of Isolation Precautions in the Management of Hospitalized Patients Colonized or Infected WithAcinetobacter baumannii

2008 ◽  
Vol 29 (12) ◽  
pp. 1118-1123 ◽  
Author(s):  
Houssein Gbaguidi-Haore ◽  
Sophie Legast ◽  
Michelle Thouverez ◽  
Xavier Bertrand ◽  
Daniel Talon
Keyword(s):  
Ecological Study ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Annual Incidence ◽  
University Hospital ◽  
Outcome Variable ◽  
Care Hospital ◽  
Aggregated Data ◽  
The Impact

Objective.To assess the impact of isolation precautions on the incidence of patients colonized or infected withAcinetobacter baumannii(case patients) in a university hospital during the period from 1999 to 2006.Design.Ecological study.Setting.The Besançon University Hospital in France, a 1,200-bed acute care hospital with approximately 50,000 admissions per year.Methods.Using Poisson regression analysis, we evaluated a total of 350,000 patient-days to determine the annual incidence of case patients. This annual incidence was used as the outcome variable, and infection control practices, antibiotic use, and other aggregated data regarding patients' age, sex, McCabe score, and immune status were used as covariates.Results.The implementation of isolation precautions was independently and negatively associated with the incidence of patients colonized or infected withA. baumannii(relative risk, 0.50 [95% confidence interval, 0.40–0.64];P< .001).Conclusions.Our study suggests that the implementation of isolation precautions, in addition to standard precautions, effectively prevents the spread ofA. baumanniiin a hospital setting.

Antibiotic Use in the Last Week of Life in Three Different Palliative Care Settings

2002 ◽  
Vol 18 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Doreen Oneschuk ◽  
Robin Fainsinger ◽  
Donna Demoissac
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Palliative Care Unit ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Marked Variability ◽  
Number Of Patients

The purpose of this study was to examine the frequency and types of antibiotics prescribed in the last week of life in three different palliative care settings, including an acute care hospital, tertiary palliative care unit, and three hospice units. A total of 150 consecutive patients were evaluated, 50 in each of the three settings. Twenty-nine patients (58%) in the acute hospital setting, 26 (52%) in the tertiary palliative care unit, and 11(22%) in the hospice settings were prescribed antibiotics. In the acute care and tertiary palliative care settings, the most frequent route of antibiotic administration was intravenous and, in the hospice setting, oral. We conclude that there is marked variability in the numbers and types of antibiotics prescribed in these different palliative care settings in the last week of life. The high use of intravenous antibiotics and the large number of patients who were still receiving antibiotics at the time of death indicate the need for further prospective studies.

scholarly journals Recommendations for incorporating palliative care education into the acute care hospital setting

1999 ◽  
Vol 74 (8) ◽  
pp. 871-7 ◽  
Author(s):  
D E Weissman ◽  
S D Block ◽  
L Blank ◽  
J Cain ◽  
N Cassem ◽  
...  
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Care Education ◽  
Palliative Care Education

Place of Death and Its Predictors for Local Patients Registered at a Comprehensive Cancer Center

2002 ◽  
Vol 20 (8) ◽  
pp. 2127-2133 ◽  
Author(s):  
Eduardo Bruera ◽  
Nancy Russell ◽  
Catherine Sweeney ◽  
Michael Fisch ◽  
J. Lynn Palmer
Keyword(s):  
Palliative Care ◽  
Hospital Setting ◽  
Vital Statistics ◽  
Place Of Death ◽  
Fiscal Year ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hospital Death ◽  
Care Hospital ◽  
At Home

PURPOSE: To help with planning of a palliative care program, we reviewed the place of death of patients who were registered at our comprehensive cancer center and explored factors that predicted death in the hospital versus death at home. PATIENTS AND METHODS: A retrospective study was undertaken of local patients who were registered at the University of Texas M.D. Anderson Cancer Center and died during the 1997/1998 fiscal year. Data from the institutional tumor registry and from the State of Texas Bureau of Vital Statistics file were collected and analyzed. The main outcome measures were place of death, patient characteristics associated with place of death, and time from registration at the institution to death. RESULTS: Of 1,793 local patients, 251 (14%) died at M.D. Anderson Cancer Center; the remaining 86% died elsewhere. A total of 617 (34%) died at home, and 929 (52%) died in an acute hospital setting (including M.D. Anderson). A total of 1,040 (58%) died within 2 years of registration. The risk of hospital death versus home death increased for patients with cancer at a hematologic site (odds ratio [OR], 4.4; 95% confidence interval [CI], 2.8 to 6.8) and black ethnicity (OR, 1.9; 95% CI, 1.4 to 2.6) and decreased for patients who paid with Medicare (OR, 0.71; 95% CI, 0.57 to 0.90). CONCLUSION: Most patients died in an acute care hospital setting and within 2 years of registration. Our data show some predictors of hospital death for cancer patients and suggest that better hospital palliative care services and integrated palliative care systems that bridge community and acute hospitals are needed.

scholarly journals Acute-Care Hospital Use Patterns Near End-of-Life for Cancer Patients Who Die in Hospital in Canada

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 109s-109s
Author(s):  
J. Tung ◽  
K. Decaria ◽  
D. Dudgeon ◽  
E. Green ◽  
R. Shaw Moxam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Acute Care ◽  
End Of Life Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Life Care

Background: Acute-care hospitals have a role in managing the needs of people with cancer when they are at the end-of-life; however, overutilization of hospital care at the end-of-life results in poorer quality of life and can worsen the patient's experience. Early integration of comprehensive palliative care can greatly reduce unplanned visits to the emergency department, reduce avoidable admissions to hospital, shorten hospital stays, and increase the number of home deaths as well as improve the quality of life of patients with advanced cancer. Aim: To describe the current landscape of acute-care hospital utilization near the end-of-life across Canada and indirectly examine access to palliative care in cancer patients who die in hospital. Methods: Data were obtained from the Canadian Institute for Health Information. The analysis was restricted to adults aged 18+ who died in an acute care hospital in 2014/15 and 2015/16 for nine provinces and three territories. The Discharge Abstract Database was used to extract acute-care cancer death abstracts. Data on intensive care unit (ICU) admissions includes only facilities that report ICU data. Results: Acute care utilization at end-of-life remains commonplace. In Canada (excluding Québec), 43% (48,987) of deaths from cancer occurred in acute-care hospitals, with 70% admitted through the emergency department (ED). In the last six months of life, cancer patients dying in hospital had a median cumulative length of stay ranging from 17 to 25 days, depending on the province. Between 18.1% and 32.8% of patients experienced two or more admissions to the hospital in the last month of life. The proportion of cancer patients admitted to the ICU in the last 14 days of life ranged from 6.4% to 15.1%. Patient demographics (age, sex, place of residence) and clinical factors (cancer type) were often predictors of hospital utilization at end-of-life and likely point to inequities in access to palliative and end-of-life care. Conclusion: Despite previous patient surveys indicating that patients would prefer to receive care and spend their finals days at home or in a hospice, there appears to be overuse of and overreliance on acute care hospital services near the end-of-life in Canada. The high rates of hospital deaths and admissions through the ED at the end-of-life for cancer patients may signal a lack of planning for impeding death and inadequate availability of or access to community- and home-based palliative and end-of-life care services. Acute care hospitals may have a role in managing the health care needs of people affected by cancer; however, end-of-life care should be an option in other settings that align with patient preferences. Standards or practice guidelines to identify, assess and refer patients to palliative care services earlier in their cancer journey should be developed and implemented to ensure optimal quality of life.

Acceptance of a Pharmacy-Based, Physician-Edited Hospital Pharmacy and Therapeutics Committee Newsletter

1992 ◽  
Vol 26 (7-8) ◽  
pp. 886-889 ◽  
Author(s):  
David J. Ritchie ◽  
Robert F. Manchester ◽  
Michael W. Rich ◽  
Mary M. Rockwell ◽  
Paul M. Stein
Keyword(s):  
Drug Class ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Perceived Usefulness ◽  
New Drugs ◽  
University Hospital ◽  
Care Hospital ◽  
Survey Results ◽  
Initial Survey

OBJECTIVE: To assess the level of physician acceptance and perceived usefulness of a pharmacy-prepared, physician-edited pharmacy and therapeutics (P&T) committee newsletter. DESIGN: Two separate surveys conducted after 7 and 24 months of publication, respectively. SETTING: 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: The initial survey was mailed to physicians after 7 months of publication and they were requested to rate various aspects of the newsletter, including timeliness of articles, usefulness of articles, quality of writing and design, and overall value of the publication on a scale of 1–4: (1 = excellent, 2 = good, 3 = fair, 4 = poor). Physicians were also asked to rank different categories of articles (articles on new drugs, drug-class reviews, topical reviews, formulary news, and articles providing P&T committee information) and were encouraged to provide comments. A separate follow-up survey conducted at 24 months asked physicians to indicate whether they (1) regularly received the newsletter, (2) regularly read the newsletter, (3) found the information in the newsletter to be useful, and (4) desired to continue receiving the newsletter. RESULTS: Initial survey results yielded mean newsletter quality scores ranging from 1.54 to 1.66. Respondents preferred, in descending order, articles on new drugs, drug-class reviews, topical reviews, formulary news, and P&T committee information. The 24-month survey revealed that 96 percent of the physicians regularly receiving and reading the newsletter found the information useful and 97 percent felt that the newsletter should continue to be published. Favorable comments were also received from several prominent physicians. CONCLUSIONS: The results indicate strong physician acceptance of a pharmacy-prepared, physician-edited newsletter and provide information about the types of articles preferred by physicians in a university hospital setting.

Church Services in a Complex Continuing Care Hospital: Why Bother?

2017 ◽  
Vol 71 (4) ◽  
pp. 274-283 ◽  
Author(s):  
Elizabeth Fisher ◽  
Jan Kraus ◽  
Kerry Kuluski ◽  
Peter Allatt
Keyword(s):  
Quality Of Life ◽  
Qualitative Analysis ◽  
Coping Strategies ◽  
Hospital Setting ◽  
Roman Catholic ◽  
Continuing Care ◽  
Care Hospital ◽  
Perceived Benefits ◽  
Spiritual Assessment

This research aimed to explore patient motivation for attending hospital-run church services in a complex continuing care hospital setting, as well as the perceived spiritual benefits as categorized by Fitchett’s 7 × 7 Model for Spiritual Assessment. Invitations to participate in one-to-one interviews were offered to all patient attendees at both an ecumenical and a Roman Catholic service over the course of several weeks. We collected 20 interviews before performing a qualitative analysis, at which point we determined that saturation of content had been reached. The key findings were that participants identified the strongest perceived benefits in Experiences and Emotions, and Rituals and Practice, suggesting that access to the ritual of Sunday church services contributes meaningfully to participants’ coping strategies and overall quality of life.

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