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Audit of Discharges From Manorlands Hospice: Destination and Survival. Viv Barros D’Sa SpR Palliative Medicine. Continuing Care . Care which people need over an extended period of time, as the result of disability, accident or illness, to address both physical and mental needs
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Audit of Discharges From Manorlands Hospice: Destination and Survival Viv Barros D’Sa SpR Palliative Medicine
Continuing Care • Care which people need over an extended period of time, as the result of disability, accident or illness, to address both physical and mental needs • May require services from NHS and / or social care • Can be provided in a range of settings eg hospital, nursing home, own home
Level 6 continuing care funding • Intended to allow people who are near to death to die in their own home or in another setting of their choice eg hospice or nursing home • Appropriate for people in the end stage of a terminal illness and likely to die in the near future ie days / weeks
Level 6 continuing care funding • Prognosis should be confirmed by lead clinician (consultant or GP) • Decisions are made by the relevant health and social services staff regarding the most appropriate and feasible package of care on a case-by-case basis, and taking into account the availability of local resources
Level 6 continuing care funding • The NHS is responsible for funding all services • Coordination of care can remain with social services if the person is already receiving support • The service is free at the point of delivery but will be subject to regular review and the care package and / or its funding adjusted as necessary
Audit aims • To see how appropriately, in terms of survival, we discharge patients to nursing homes • To find out how appropriately we apply for Level 6 Continuing Care Funding (CCF)
Questions to be answered • How long did patients discharged to nursing homes, with and without CCF, live? • How many patients, with and without CCF, died within 6 weeks (42 days) of discharge?
Methods • Case note review of all patients discharged from Manorlands in 2003 • Hand search through cardex of deceased patients
Results • 100 patients discharged from Manorlands in 2003 • 117 in-patient episodes • Notes not available for 9 patients (17 in-patient episodes) • 100 patient episodes recorded
Discharges to nursing homes • 11 discharges on CCF • 5 lived < 42 days • 1 patient died after 4 days • excluding this, range 22 – 37 days • 6 lived > 42 days • range 44 – 107 days • median 76 days • 2 lived > 100 days • 2 discharges not on CCF • Both lived > 42 days • 62 and 66 days
Discharges home on CCF • 12 patient episodes • 7 lived < 42 days • range 3 – 13 days • 4 lived > 42 days • range 61 – 98 days • 1 still alive • over 18 months since CCF allocated
NH discharges: conclusions • 13% of all discharges were to nursing homes • In general, these seemed to be appropriate in terms of survival, with only one patient surviving less than 22 days • Patients not on CCF did not live longer than some of those with CCF
CCF discharges: conclusions • 24% of discharges were allocated CCF • Approximately half went home and half to nursing homes • In half of these cases the patient died within 42 days, meaning our predictions of survival were correct • Predictions were incorrect in nearly half of cases
CCF discharges: conclusions • Did not take into account patients for who discharge with CCF was planned, but who became too unwell to leave the hospice • About a fifth of those discharged without CCF died within 42 days
Answers to questions • How appropriately do we discharge patients to nursing homes? • How appropriately do we apply for Level 6 Continuing Care Funding?
