Outcomes of palliative care unit inpatients assessed for placement in residential aged care

With the ageing population, increased pressure on the health care system and decreased length of stay targets, it has become increasingly important for inpatient palliative care units (PCU) to correctly assess which patients are more suitable for ongoing inpatient palliative care or residential aged care. A proportion of patients admitted to the PCU are discharged home. However, for the proportion of patients where discharge home is not possible, an assessment by the Aged Care Assessment Service (ACAS) maybe undertaken to arrange discharge to residential care.

Some palliative patients die while undergoing this process which is time, energy and emotionally consuming for staff, patients and family. This project aims to explore the outcomes of patients who underwent ACAS assessments in Wantirna Health PCU and to identify if patients could be more effectively targeted for ACAS assessments.

Study population included patients who were ACASed during a period of January 2008 till March 2010 where 100 consecutive patients who satisfy the selection criteria were selected. Patient's demographics and clinical information were obtained via electronic medical records. Inclusion criteria were all patients referred to social worker for ACAS assessment. Exclusion criterion was patients who were originally from nursing horne/residential care.

Outcome measures were death and discharges (home, nursing home or transitional care) among cancer and noncancer patients. Time from admission to ACAS and time from ACAS to separation were recorded. 73 patients had a cancer diagnosis and 27 had non-cancer diagnosis. 62 ACASed patients were discharged and 38 died in PCU. Of those who died, 33 (86.8%) were cancer patients and 5 (13.2%) were non-cancer patients. The average time from admission to ACAS was 22 days. The average time from ACAS to separation (discharge/death) was 19 days. Follow up in June 2010, showed 14 patients were still alive, the majority being non-cancer patients (13 (92.9%)).

From these observations, non-cancer patients are likely to live longer and to be discharged compared to cancer patients. Therefore, ACAS should be performed sooner in non-cancer patients. Prognosis for cancer patient discharge from PCU is poor with 98% dying. There is no specific pattern for outcomes of NSCLC as 60% died during ACAS process. Further studies with a larger sample size involving multiple PCUs are required to provide a broader and more accurate overview.