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Identifying Alternatives to Hospital for People at the End of Life

This report presents the key findings from a project undertaken with Sheffield health and social care organisations, in conjunction with the National Audit Office value for money study on the delivery of end of life care (EOLC) services in England. The aim of the project in Sheffield has been to explore the potential for change in care pathways for people at the end of life, and in particular to consider alternatives to patients dying in hospital. The central focus of the project was a retrospective survey based on hospital medical records of 348 out of 420 adults in Sheffield PCT who died in October 2007, and were known to Sheffield Teaching Hospitals NHS Trust. Over half the patients died in hospital and the survey was able to identify and review case notes for 200 of the 215 people who died in hospital that month, and to assess whether alternatives to hospital stay might have been possible if appropriate services and clinical processes had been in place. The survey was undertaken by experienced clinical staff with particular interest in issues of end of life care. Some key findings from the survey were: • As expected, most people dying were over 65 • Using Gold Standard Framework categories, frailty (42%) was more common as the underlying reason for dying than cancer (30%) or chronic disease (20%). 8% were assessed as dying 'unexpectedly'. • Up to 25% of those dying may have had dementia. • Over half (52%) died in hospital, including 2% on a palliative care unit; of the 18% dying at home about half were cancer patients, and a quarter in the frailty group. • Surveyors identified alternatives to dying in hospital for 80 out of 200 surveyed (40%), evenly split between home based and bed based alternatives.-Cancer patients mainly needed palliative care-Frail patients needed services involving general or specialist nursing, with some palliative care as part of their overall end of life care.-For chronic disease patients alternatives were only identified for 7 out of 44 patients dying in hospital (16%) • Care home residents who die in hospital are more likely to have had an admission which might have been avoided than others. Overall over 60% of residents dying did so in their own care home. • Allowing for people who died but were not included in the survey, only 26% of those living in their own homes died there. …