Utilización hospitalaria en días festivos por pacientes en situación de cuidados paliativos

Aims: To describe hospital needs of patients in palliative care (PC) for festivities and to describe if a subgroup of our patients demands more health care in festivities than the rest. Method: Retrospective study of a cohort of patients in PC admitted through the emergency department between 02/04/2002 and 12/31/2009 in a hospital caring for 200.000 people. We calculated the admittance index (AI) for festivities and working days for each variable. For the years 2008 and 2009 we recorded specifically admittances to the emergency department for dyspnea, delirium, pain, metastasis and a Karnofsky index (KI) < 50. Results: From 1.495 patients, 3.063 episodes were identified with a mean age of 68,9 years (SD 13,29). The AI in festivities was 37% in PC pacients vs. 36% in Internal Medicines (p 0,252). The episodes resolved at the emergency department on festivities was 1,24 (IC 95%: 1,062-1,46) higher than those needing admission (p 0,007). The patients in agony (39,3 % vs. 36,7%), those with dyspnea (35,3% vs. 32,5%), delirium (35% vs. 33,1%), pain (34,3% vs. 33,8%), patients with (32,9%) and without (45,6%) metastases and KI<50% (35,1%) or <50% (28,5%) were attended more frequently at the emergency department although not significantly. Conclusions: Hospital demand was a little higher for PC patients consulting at the emergency department and not needing hospital admittance than for those needing it. This underscores the need to organize the hospital care of this type of patients during these periods, mainly in the emergency departments.