In this cohort, palliative care referral and EOLCP were commenced in less than 50% of patients, highlighting significant variations in clinical care. These data support the need to promote awareness of ACP, particularly in patients with prior stroke or significant comorbidities. This may help reduce potentially futile invasive investigations and treatment.

Background and aimsImmunoprophylaxis (IP) has proven effective in reducing hospitalisations from respiratory syncitial virus (RSV) infection among high-risk infants. We aimed, 1) to compare direct costs of RSV IP administered for high-risk infants in the home versus hospital settings, 2) to compare the compliance of the IP schedules, and 3) to analyse the post-IP RSV hospitalisations before and after the introduction of home IP.MethodsSingle-centre, multi-year retrospective review of RSV IP in a defined birth cohort was undertaken. High-risk infants from a University Maternity Hospital in Ireland from 2003–2008 received IP in the hospital, and from 2009–2012 at home through an approved provider. Compliance was scored and post-prophylaxis RSV hospital admissions, if any, were recorded. Computerised data logged by the home care provider at a National level from 2007 -2012 were analysed, as well as National Virus Reference Laboratory surveillance data over a ten year period. University Hospital Ethics and Research Committee approved the study.ResultsUnit cost of RSV IP administration was more favourable in the home setting, especially when taking into account breakthrough infections and potential nosocomial admissions contributed by exposure to the hospital environment. Since its introduction, the home IP programme prevented a substantial number of hospital encounters in Ireland, and there was a resulting direct saving for the Health Service Executive from 2009–2012. Compliance was improved from 56–79% prior to home administration to 90–92% (p < 0.0001). Calculations were based on 2012 costs and unit price of IP drug (palivizumab) at the point of delivery.ConclusionsIn addition to the significant improvement in compliance and prevention of potential breakthroughs, considerable professional hospital hours during the busy winter season could also be freed up by ‘outsourcing’ RSV IP from the hospital environment to the home setting. Home IP offers additional opportunistic and societal cost savings while promoting healthcare quality improvement.