Transfer Outcomes for LOROS Patients sent to Acute Hospitals

PURPOSE: A short service evaluation, to retrospectively identify and review the outcomes for patients transferred to acute hospitals from the LOROS Hospice, for investigations and or treatment. This study was done to better understand the local practices and whether the outcomes reflected the local Hospice values and NICE standards for quality end of life care.

METHOD: Data was collected by first identifying all patients admitted to the LOROS hospice who were subsequently transferred to an acute hospital for treatment. This list was generated by reviewing the hospice ward clerks diary of admissions, which included a record of all patients admitted to the hospice, but also all patients transferred to an acute hospital. The records available were from the 1st Jan 2015 to the 6th July 2016. This period was therefore chosen for the retrospective study. Patient outcomes were found using electronic discharge summaries, hospice electronic records and for one patient, by formally requesting hospital notes from the main hospital data file store. A review of the notes allowed a list of data to be collected including: patient demographics, diagnosis, reason for admission to hospice, reason for transfer to acute hospital, length of stay in hospice pre-transfer, length of stay in acute hospital, treatment actually given, complications encountered, discharge destination and outcome longer term. A summary for each of the patients transferred was obtained and this was summarised in both tables and graphs.

SUMMARY OF RESULTS: 28 patient transfer events were identified in the study period. The results showed that the intended treatment or reason for transfer was achieved in 79% of transfers (22 of 28). 14% (3 of 22) suffered a complication from the treatment/procedure/transfer. 48% survived >30 days post discharge. 4%(1 of 28) died in the acute hospital. 24% (7 of 28) died within 5 days of discharge.

CONCLUSION: The service evaluation showed the outcomes for patients transferred to acute hospitals for investigations and treatments resulted in better than expected outcomes for patients. A large proportion of patients survived with the original aim of the transfer being achieved. These findings could help future decision making for hospice doctors when deciding if patients should be transferred to acute hospitals for treatment/investigations, or be managed at the hospice. The finding are however subject to a number of limitations. These include the small number of patients studied, limitations of the accuracy of patient transfers identified (not all patients sent to hospital were recorded in the ward clerks diary) and a level of subjectivity when determining overall if something is a “good” outcome for an individual.