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“Significantly” fewer A&E visits at end-of-life for patients living near hospice

Author: Petrina Vousden
28 December 2016

PEOPLE are more likely to be rushed to an Emergency Department and admitted to hospital wards at end of life in Ireland if there is no hospice unit in their area, a new study shows.

The researchers argue that experiences of patients at the end of life would be better if hospice services could prevent some hospital admissions.

Overall the study found patients are “significantly” less likely to be admitted to a busy acute hospital in the last three months of their lives in the Mid West of Ireland where an inpatient hospice exists compared to the Midlands or South East.

Where no hospice bed is available there is more chance of a hospital admission , according to the research carried out by a team from Trinity College Dublin and the Economic and Social Research Institute think tank.

“It is reasonable to argue that experiences of patients will be better where hospice services can prevent some hospital admissions,” the report states.

The researchers said it was not possible to determine if the admissions to acute hospitals were appropriate.

But added: “There is extensive evidence that many admissions to acute hospitals are not appropriate and reflect the lack of viable alternatives. This study shows that where in-patient hospice services are available the level of admissions with both malignant and non-malignant diseases to acute hospital beds is significantly lower in the last three months of life.

“Patients in hospice beds receive many of the same services that are provided in hospitals as well as Specialist Palliative Care.

“While hospice beds and hospital beds are not exact substitutes, when no hospice bed is available there is more chance of a hospital admission. It is reasonable to argue that experiences of patients will be better where hospice services can prevent some hospital admissions.”

The report ; Economic Evaluation of Palliative Care in Ireland which has been published on-line by The Atlantic Philanthropies looked at specialist palliative care services in three regions in Ireland.

They found a variety of services in HSE Midlands Area incorporating Laois, Offaly, Longford and Westmeath, the HSE Mid-West Area incorporating Clare, Limerick and North Tipperary and HSE South East Area including South Tipperary, Waterford and Wexford.

The Mid West has a facility with in-patient and ambulatory palliative care services while in the Midlands and South East specialist palliative care services are mainly provided on an outreach basis.

Six months prior to death most people in all areas wanted to die at home.

“However by the last week of life this proportion had deceased in all areas, most likely reflecting an individuals’s increasing level  of need and wish not to place this burden on family.

“Almost 75 per cent of patients in this study died in the location for which they had stated a preference in the last week of life.

“In the Mid West where in-patient hospice services are available, more patients died in the hospice setting and fewer in hospital,” the study found.

Overall the experiences of 215 people who died in the three regions were examined for the research.

Researchers interviewed people involved in the deceased person’s care or decision making in the last year of their life.

The frequency of visits by people to the emergency department in the last three months of life was 2.4 times higher in the South East compared to the Midlands and three times higher than in the Mid West.

Professor Charles Normand of TCD who who led the research said: “Evidence from this study shows that more developed palliative care reduces the cost of other health services. While overall savings are probably not achieved, much of the cost of palliative care can be paid by savings from hospital care.”

The Irish Hospice Foundation welcomed the report. The IHF has been campaigning for a hospice in the Midlands area.

IHF chief Sharon Foley said recently: “Everyone deserves a good death and we have a duty to work together to ensure that can happen. This is about people who are dying and the families that are left behind. The Midlands is being very much denied a full range of palliative care services.”

“The region is currently an end-of-life care “blackspot” with no specialist inpatient hospice unit to act as a hub to support and enhance services in Laois, Offaly, Longford and Westmeath.

 “Without a hospice, and the resultant special palliative care services that comes with it, patients are being denied the best possible care on their final journey.

“We all need to sing with the one voice and work together for advancements. Not having a full service means patients with complex symptoms which cannot be managed in homecare have to be transferred to an acute hospital, often through a busy A&E Department. It also means many more people die in acute hospitals.

“Double the percentage of people with cancer who die in the Midlands die in an acute hospital; compared to other areas where there is a full Level III service.”

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