title: Appropriateness and avoidability of terminal hospital admissions: Results of a survey among family physicians.
abstract: Although the acute hospital setting is not considered to be an ideal place of death, many people are admitted to hospital at the end of life.
  
  
  
  To examine what proportion of terminal hospital admissions among their patients family physicians consider to have been avoidable and/or inappropriate; which patient, family physician and admission factors are associated with the perceived inappropriateness or avoidability of terminal hospital admissions; and which interventions could have prevented them, from the perspective of family physicians.
  
  
  
  Survey among family physicians, linked to medical record data.
  
  
  
  Patients who had died non-suddenly in the acute hospital setting of a university hospital in Belgium between January and August 2014.
  
  
  
  We received 245 completed questionnaires (response rate 70%) and 77% of those hospital deaths ( n = 189) were considered to be non-sudden. Almost 14% of all terminal hospital admissions were considered to be potentially inappropriate, almost 14% potentially avoidable and 8% both, according to family physicians. The terminal hospital admission was more likely to be considered potentially inappropriate or potentially avoidable for patients who had died of cancer, when the patient's life expectancy at the time of admission was limited, by family physicians who had had palliative care training at basic, postgraduate or post-academic level, and when the admission was initiated by the patient, partner or other family.
  
  
  
  Timely communication with the patient about their limited life expectancy and the provision of better support to family caregivers may be important strategies in reducing the number of hospital deaths.
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Thijs
authors.initials: T
authors.lastname: Reyniers
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.|2 Department of Medical Oncology, Ghent University, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: 3 EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: 4 Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.affiliation: 5 IT Department, Ghent University Hospital, Ghent, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Sijnave
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010821:Physicians, Family; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Hospital admission; family physician; hospital records; palliative care; patient admission; survey