title: Unscheduled care admissions at end-of-life - what are the patient characteristics?
abstract: Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients' preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission. A retrospective, observational study was conducted in all unscheduled admissions at end-of-life at a single health board in South Wales, UK over a period of one month. The result showed that 47% of patients who died within 48hrs of unscheduled admission are considered to be palliative. The majority of these patients were admitted via 999 ambulances and out of normal working hours (65%). They were elderly (median age 80) and had a poor performance status (78%). Over 1/3 (39%) were admitted from a nursing or residential home. Less than a quarter (22%) had an advance care plan in place.
authors.affiliation: Consultant in Acute Medicine and Honorary Senior Lecturer in Palliative Medicine, Royal Gwent Hospital, Aneurin Bevan University, Health Board, Newport, NP20 2UB.
authors.forename: Emma
authors.initials: E
authors.lastname: Mason
authors.affiliation: Consultant in Palliative Medicine, Royal Gwent Hospital.
authors.forename: Debbie
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: Consultant in Palliative Medicine, Nevill Hall Hospital.
authors.forename: Meg
authors.initials: M
authors.lastname: Williams
authors.affiliation: ST3 in Palliative Medicine, Wales Deanery.
authors.forename: James
authors.initials: J
authors.lastname: Davies
mesh_terms: D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods / Q000458:organization & administration; D019452:Terminally Ill / Q000145:classification / Q000706:statistics & numerical data; D014852:Wales / Q000453:epidemiology