scholarly journals TP9.2.7Acute Surgical Admissions at the End of Life: an Analysis of Deaths in Non-operatively Managed Patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hollie Clements ◽  
Michael El Boghdady ◽  
Afshin Alijani
Keyword(s):  
Surgical Intervention ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Planning ◽  
Do Not Resuscitate ◽  
Bowel Ischaemia ◽  
Time To Death ◽  
Surgical Emergencies ◽  
Data Points ◽  
Comorbidity Index

Abstract Aims Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Methods This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusion Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

scholarly journals 444 Acute Surgical Admissions at the End of Life: An Analysis of Deaths in Non-operatively Managed Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Clements ◽  
M El Boghdady ◽  
A Alijani
Keyword(s):  
Surgical Intervention ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Planning ◽  
Do Not Resuscitate ◽  
Bowel Ischaemia ◽  
Time To Death ◽  
Surgical Emergencies ◽  
Data Points ◽  
Comorbidity Index

Abstract Aim Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Method This single-centre retrospective, observational study collected data points for a 12-month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis, or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusions Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

Easing of Suffering in Children With Cancer at the End of Life: Is Care Changing?

2008 ◽  
Vol 26 (10) ◽  
pp. 1717-1723 ◽  
Author(s):  
Joanne Wolfe ◽  
Jim F. Hammel ◽  
Kelly E. Edwards ◽  
Janet Duncan ◽  
Michael Comeau ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Geometric Mean ◽  
Symptom Control ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Children With Cancer ◽  
Adjusted Risk

Purpose In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life. Methods Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort). Results In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002). Conclusion Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

scholarly journals 05 Profile of a Geriatric Neurosurgical Service

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Kareena Malone ◽  
Fiona Kinsella
Keyword(s):  
Catchment Area ◽  
Surgical Intervention ◽  
Traumatic Event ◽  
Service Planning ◽  
Service Development ◽  
Irish Population ◽  
Complex Needs ◽  
National Trauma ◽  
Data Points ◽  
National Profile

Abstract Background According to the 2016 CSO figures the age category of 65 and older saw the largest increase in the Irish population since 2011, rising by 102,174 to 637,567, a rise of 19.1%. This remains a major concern for a North Dublin teaching hospital as its catchment area has a 20% higher proportion of > 65’s and > 85’s than the national average. This catchment area profile has the potential to impact on the profile of the in-catchment admissions while the National profile will impact on the national specialities including neurosurgery. Aim To profile the geriatric neurosurgical population and provide insight that facilitates future service planning and delivery. Methods To accurately capture the data, all ward lists for the month of June and July 2017 were reviewed to identify appropriate patients. All patients on any ward within the hospital, under the care of a neurosurgeon, were included in the data collection. Patients in intensive care that did not transfer to the wards were excluded. Data points including age, sex, consultant, co-morbidities, mobility status and surgical intervention were captured. Results 120 patients ≥ 65 years were admitted to the neurosurgical service between June and July 2017; 45 (38%) between 60-69, 60 (50%) 70-79, 13(10%) 80-80 and two (2%) ninety years or older. The two most common reasons for admission were non-traumatic cerebral bleeds (N= 40; 34%) and cerebral tumours (N= 38; 32%). Patients had on average four co-morbidities, with cardiac being the most common. 17 patients were admitted post a traumatic event; 13 low impact falls, 3 high impact falls and one assault. The average LOS for these patients was 11.3 days. Conclusion This profile highlights the complex needs of this population and the increasing burden on existing neurosurgical resources as the population continues to age. Future resource allocation and service development, including the National Trauma Strategy, needs to consider the needs of the aging neurosurgical population.

A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction

2016 ◽  
Vol 34 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Emmanuel Gabriel ◽  
Moshim Kukar ◽  
Adrienne Groman ◽  
Amy Alvarez-Perez ◽  
Jaclyn Schneider ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Management Problem ◽  
Do Not Resuscitate ◽  
Stage Iv Cancer

Background: Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process. Methods: A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status. Results: A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006). Conclusion: Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

Role of palliative care department in modifying ICU admissions for patients with advanced cancer: A study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19517-e19517 ◽  
Author(s):  
Rakesh - ROY
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Care Service ◽  
Information Source ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Exclusion Criteria ◽  
Care Department ◽  
Operative Care

e19517 Background: Admission of cancer patients are on the rise in the Intensive Care Unit due to advancement in healthcare facilities. But limited number of ICU beds, health resources and lack of structured Palliative Care services are a matter of concern. Methods: A retrospective study was conducted in an Indian tertiary cancer centre from Jan – Jun 2010 to find out total number and cause of ICU admission of advanced cancer patients when a Palliative Care Department did not exist. Information source were case files and interviews after appropriate consent. Exclusion criteria - age < 18 years, post operative care, complications arising from a major surgery, established oncological emergencies, patients with curative intent. With a 24 hr Palliative Care department under operation from Aug 2010 - another similar study was performed from Jan – Jun 2011. Results: Jan – Jun 2010: Total admissions 542. 297 patients matched the exclusion criteria. Of the remaining 245 patients (45.2%) considered for the study 35 patients (14.2%) died. 11 patients (4.4%) were put on ventilator. Average occupancy of bed 5 days. Commonest cause was respiratory distress. Review of the case notes revealed 54 patients (22%) were admitted due to lack of Palliative Care service. Study was repeated from Jan – Jun 2011 after the initiation of a Palliative care Department from Aug 2010. Out of 487 patients, 195 patients (40%) were considered for study. 18 (9.2%) died. 6 patients (3%) were put on ventilator. The average duration of stay was 4 days. Components of Palliative Care like good communication, early consent from patients as to where they wish to die, do not resuscitate policy for some patients in the background of ethical issues, 24 hour Palliative care service, emergency helpline, home based care, good psychological counselling etc were identified as the key reasons for reduced admissions. Conclusions: Effective round the clock Palliative care service can increase ICU bed turnover, reduce misery of the patients and their family members, save resources, giving patients with longer survival chances a hope to live longer.

scholarly journals Enhancing palliative care delivery in a regional community in Australia

2006 ◽  
Vol 30 (3) ◽  
pp. 370 ◽  
Author(s):  
Jane L Phillips ◽  
Patricia M Davidson ◽  
Debra Jackson ◽  
Linda Kristjanson ◽  
Margaret L Bennett ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Delivery ◽  
Local Community ◽  
Care Delivery ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Planning ◽  
North Coast ◽  
Care Needs ◽  
Integrated Network

Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalised integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

scholarly journals Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

2020 ◽  
Vol 34 (9) ◽  
pp. 1193-1201 ◽  
Author(s):  
Anna E Bone ◽  
Anne M Finucane ◽  
Javiera Leniz ◽  
Irene J Higginson ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Descriptive Analysis ◽  
Palliative Care Service ◽  
Routine Data ◽  
Population Based ◽  
Service Planning ◽  
Care Homes ◽  
Care Needs ◽  
Health And Social Care

Background: COVID-19 has directly and indirectly caused high mortality worldwide. Aim: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. Design: Descriptive analysis and population-based modelling of routine data. Participants and setting: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. Results: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. Conclusion: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

scholarly journals 77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
D Hibbert
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Plan ◽  
Specialist Palliative Care ◽  
Experience Of Care ◽  
Outcomes Of Care ◽  
Specialist Palliative Care Service ◽  
The Right

Abstract   NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

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