Audit of Discharges From Manorlands Hospice: Destination and Survival Viv Barros D’Sa SpR Palliative Medicine

Continuing Care  Care which people need over an extended period of time, as the result of disability, accident or illness, to address both physical and mental needs  May require services from NHS and / or social care  Can be provided in a range of settings eg hospital, nursing home, own home

Level 6 continuing care funding  Intended to allow people who are near to death to die in their own home or in another setting of their choice eg hospice or nursing home  Appropriate for people in the end stage of a terminal illness and likely to die in the near future ie days / weeks

Level 6 continuing care funding  Prognosis should be confirmed by lead clinician (consultant or GP)  Decisions are made by the relevant health and social services staff regarding the most appropriate and feasible package of care on a case- by-case basis, and taking into account the availability of local resources

Level 6 continuing care funding  The NHS is responsible for funding all services  Coordination of care can remain with social services if the person is already receiving support  The service is free at the point of delivery but will be subject to regular review and the care package and / or its funding adjusted as necessary

Audit aims  To see how appropriately, in terms of survival, we discharge patients to nursing homes  To find out how appropriately we apply for Level 6 Continuing Care Funding (CCF)

Questions to be answered  How long did patients discharged to nursing homes, with and without CCF, live?  How many patients, with and without CCF, died within 6 weeks (42 days) of discharge?

Methods  Case note review of all patients discharged from Manorlands in 2003  Hand search through cardex of deceased patients

Results  100 patients discharged from Manorlands in 2003  117 in-patient episodes  Notes not available for 9 patients (17 in-patient episodes)  100 patient episodes recorded

Discharge destination

Survival NOT ON CCFON CCF Died < 42 days Died > 42 days Still alive 07/ Data incomplete 5 1 TOTAL 76 24

Discharged to nursing homes: 13 NOT ON CCFON CCF Died < 42 days after discharge - 5 Died > 42 days after discharge 2 6 TOTAL 2 11

Discharges to nursing homes  11 discharges on CCF 5 lived < 42 days  1 patient died after 4 days  excluding this, range 22 – 37 days 6 lived > 42 days  range 44 – 107 days  median 76 days  2 lived > 100 days  2 discharges not on CCF Both lived > 42 days  62 and 66 days

Discharged home: 78 NOT ON CCFON CCF Died < 42 days after discharge 15 7 Died > 42 days after discharge 30 4 Still alive 07/ TOTAL 66 12

Discharges home on CCF  12 patient episodes 7 lived < 42 days  range 3 – 13 days 4 lived > 42 days  range 61 – 98 days 1 still alive  over 18 months since CCF allocated

NH discharges: conclusions  13% of all discharges were to nursing homes  In general, these seemed to be appropriate in terms of survival, with only one patient surviving less than 22 days  Patients not on CCF did not live longer than some of those with CCF

CCF discharges: conclusions  24% of discharges were allocated CCF  Approximately half went home and half to nursing homes  In half of these cases the patient died within 42 days, meaning our predictions of survival were correct  Predictions were incorrect in nearly half of cases

CCF discharges: conclusions  Did not take into account patients for who discharge with CCF was planned, but who became too unwell to leave the hospice  About a fifth of those discharged without CCF died within 42 days

Answers to questions  How appropriately do we discharge patients to nursing homes?  How appropriately do we apply for Level 6 Continuing Care Funding?

Place of death of discharged patients