End-of-life care in hospital: a descriptive study of all inpatient deaths in 1 year
End-of-life care in hospital: a descriptive study of all inpatient deaths in 1 year
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DOI：
10.1177/0269216309106460
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发表时间：
2009-10-01
影响因子：
4.4
通讯作者：
Purdy, S.
中科院分区：
文献类型：
--
作者：
Abel, J.;Rich, A.;Purdy, S.
本研究的目的是确定有多少病人谁死在一个地区综合医院在英格兰可能已经能够在家里照顾，以获得每个住院病人的费用，估计最大的资源影响的护理包为这些病人，并计算节省住院，可用于发展社区服务。这些目标取决于全面执行“生命终结战略”。对英格兰西南部一家地区综合医院一年内所有住院死亡人数进行了描述性研究。数据收集-2006年6月初至2007年5月底在医院死亡的所有患者的病例记录。共审查了研究期间死亡的627例患者的599份病例记录。共有331名患者（56%）未被评估为处于生命的最后一年。在其余44%的患者中，152例（26%）明显处于生命的最后一年，110例（18%）有显著的合并症，可能被认为处于生命的最后一年。共有399名（67%）患者因最终疾病而适当入院，194名（33%）患者可以在家中接受治疗。至少有119人（20%）明确和75人（13%）可能留在家里。平均住院费用为3173磅每例患者。共有77名（13%）患者从疗养院入院，其中53名（69%）可能留在疗养院死亡。在地区综合医院死亡的所有患者中，共有44%患有危及生命的慢性疾病。如果有良好的临终服务，最多三分之一的医院死亡病例本可以在家里得到照顾。在委托临终关怀服务时，可以计算有多少额外的患者可能需要社区护理包，以及这些服务可以从医院重新分配到社区的成本。
The objectives of this study are to ascertain how many patients who died in a district general hospital in England might have been able to be cared for at home, to obtain the cost of each inpatient stay, to make an estimate of the maximum resource implications of care packages for these patients, and to calculate the savings in hospital admissions that could be used for the development of community services. These objectives are dependant on full implementation of the End of Life Strategy. A descriptive study of all inpatient deaths in one year in a district general hospital in the south west of England was conducted. Data collection - case notes of all patients who died at the hospital from the beginning of June 2006 to end of May 2007. A total of 599 case notes of 627 patients who died in the study period were reviewed. A total of 331 patients (56%) were not assessed as being in the last year of life. Of the remaining 44%, 152 (26%) were clearly in the last year of life and 110 (18%) had significant co-morbidities and could probably have been recognised as being in the last year of life. A total of 399 (67%) of patients were appropriately admitted to hospital for their final illness, 194 (33%) could have been looked after at home. At least 119 (20%) clearly and 75 (13%) probably could have stayed at home. The mean cost of admission was 3173 pound per patient. A total of 77 (13%) of patients were admitted from nursing homes and 53 (69%) of these could have stayed in the nursing home to die. A total of 44% of all patients who died within the district general hospital had chronic life threatening illnesses. A maximum of one third of all hospital deaths could have been looked after at home if excellent end of life services were in place. When commissioning end of life care services, it is possible to calculate how many extra patients may need community care packages and the cost that could be redistributed from hospital to community for these services.