63 To explore factors involved in ‘short’ end of life care admissions within a hospice setting

Background Transfer of patient care to inpatient hospice settings is often associated with improved symptom control, psychological well-being and reduction of carer stress. Patients and their carers may not receive the full range of benefits of hospice care when admissions are short, less than 48 hours. Despite the brevity of the admission stay, families report very positively on the care experience of their loved one. We aimed to explore patient characteristics and factors that could contribute to short inpatient hospice stays. Methods Prospective case note review of deaths at St Michael’s Hospice with a short (less than 48 hrs) length of stay. Data was collected over a 1-year period, comprising referral source, reason for admission and patient preferences. Results 225 inpatient deaths occurred over the 1-year period.; 51 patients (23%) died within 48 hours of admission. The majority of patients had metastatic cancer diagnosis (88%), coupled with poor performance status (ECOG 4(90%)) and the vast majority already known to our Community Palliative Care Team (86%). Given the challenges with prognostication, 98% of individuals were identified as being in the last days of life. Common themes were acute and sudden clinical deterioration, uncontrolled symptoms, preference to delay admission for as long as possible and finally, a strong patient or family preference for admission. Patients were admitted within 24 hours of referral (88%). Conclusion This piece of work highlights certain characteristics; metastatic cancer, poor performance status and individuals already under the community service, linked to ‘short’ inpatient stays. Patient and family documented preferred place of care, clearly plays an important role. This work underpins the need for advance care planning from both patient and their family. Therefore, rather than length of stay determining patient and carer experience, the tangible sharing of patient and carer preferences across a health system is key.