1. Audit into length of stay on IPU at Y Bwthyn Newydd, Bridgend
Project number 495 ABMU Trust
Dr Ria Fraser, Dr Becky Geach, Dr Angharad Renault, Sister Teresa Pace, Dr Fiona Rawlinson

2. When there is pressure on beds we seem to think…
Patients are ‘bed blockers’ – if they are in a bed for a long time
Everyone is waiting for CHC forms
Everyone is older than 65
We are wary of noncancer patients because of delays getting stuck

3. Why audit?
Can we see if there are common themes resulting in patients staying for a long time on the IPU?
Specialist needs
Gaps in supporting services
Family issues
Can we plan beds any more efficiently?

4. Set standards:
6 weeks should be a reasonable maximum length of time for a patient to be on the SPC IPU
2 weeks symptom control
4 weeks
ongoing symptoms
case conferences even if identified early,
CHC forms etc

5. Patients between 1.4.08 to 31.3. 09 staying longer than 42 days
Minimum LOS = 46 days
Max = 103 days
Mean = days
3 males, 6 females
Age range: 40 – 73 ( average = 60 years)

6. Clinical diagnosis Prostate Ca + bone and lung mets (cord comp)
Ca endometrium + lung, bone and liver mets (cord comp)
Ca lung + bone mets (cord comp)
2 x Ca lung + bone mets
Ca endometrium and peritoneal spread
Ca Rectum + bone mets
Melanoma + brain, liver, bone and lung
Ca ovary + retroperitoneal lymph nodes

7. Who was at home? Husband, other family nearby but not close
Husband diagnosed with lung cancer and died while she was an inpatient
Wife
Husband and son
(dependent)
Husband, 2 children (16+18)
2nd husband, daughter nearby
Concerns about vulnerable adult status of wife
Husband
Husband significant depression
Daughter, other daughter nearby
Daughter at home significant coping difficulties. Communication issues on admission
Mother, Father and brother
Huge psychological issues about him dying at home

8. Questions asked: Key symptoms on admission
Information from admission form
Date for discharge that was missed?
If so, what area was responsible for the delay?

9. Communication issues
Strong denial in 2 spinal cord compression patients making realistic rehab a challenge
1 patient actively colluding with us against family on admission

10. Was there a date for discharge that was missed?
Sometimes hard to tell from the notes!
5 = no – complex or unstable symptoms
4 – yes
manual handling issues for the DN/family
CHC form delays and increasing pain
Became too unwell at first discharge date but plateau’d for 2 weeks after before final illness
Pain changed in nature and severity

11. For those 4, who was at home and what were the issues?
Wife
60 yrs old cord comp
Recurrent infections and a change in pain
2nd husband , daughter lived locally
73 yrs old Cord comp
Difficulties over realistic expectations for rehab
Husband
58 years old
COMPLEX unstable pain in the few months prior to this point
Husband significant depression
Daughter, other daughter lived nearby
70 years old daughter at home significant coping difficulties. Communication issues on admission – delay before were allowed to talk with family
Manual handling training for DN and family

12. What happened to the 9:
2 ( with cord comp) went home – both needed follow up visits to review and repeat setting realistic expectations
7 died in YBN
( No one went to a nursing home)

13. Case conferences?
Yes in 7 out of the 9

14. Could they have been looked after anywhere else if not home?
No - symptoms and death of husband
No – cord comp and difficult pain
No – difficult distress in young patient
No – difficult pain
No – young patient – family issues about death of a son
No – unstable symptoms once discharge date had been passed
??Possibly – v/a status and mood but where? Psych?
??Possibly – manual handling and working with family issues, but fewer symptoms

15. Those staying more than 6 weeks in YBN during this time frame are:
Not over 80 with multiple comorbidities waiting for nursing home placement
Not all waiting for CHC forms
Do have complex issues
Are not BIG numbers
Are not non cancer patients