P-114 End-stage chronic liver disease: a look at the last year of life

Abstract

66% of patients had a malignancy; 34% had non-malignant disease.27% of patients were discharged home, 28% of patients died and 23% were transferred to a palliative care unit.Median duration of episode of care was 1 day; the mean was 3 days (range 0-157 days). Discussion The opening of NSECH has transformed the hospital palliative care liaison team. The provision of palliative care within an acute, emergency care hospital provides particular challenges, including acute care for patients who are dying, and the rapid discharge of patients with complex needs and high dependency. Partnership working with an acute trust has enabled this rapid development in service in an emerging area of palliative care provision. Burdensone transfers to acute hospital are common and potentially unnecessary amongst nursing home residents with advanced dementia approaching last days of life Aim To identify and appraise influencing factors associated with acute care utilisation amongst nursing home residents with advanced dementia in final three months of life with view to inform adaptation of an existing conceptual model. REFERENCESTo evaluate effectiveness of identified interventions influencing acute care utilisation amongst this cohort. Methods Six electronic databases(MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library) were searched from inception through March 2015 for studies pertaining to the above research question supplemented by hand-searching selected journals, reference and citation tracking, contact with experts and grey literature search. Following a systematic process, key studies were identified, data extracted and results collated. Strength of evidence was determined according to quality, quality of studies and consistency of findings for individual factors and assigned as low, moderate and high to inform a conceptual model. Results were thereafter harmonised using the process of narrative synthesis.Results No intervention studies meeting criteria for inclusion in the review were identified. Eight studies were identified reporting four demographic, three clinical and five environmental factors across three countries and 5 02 323 individuals. High strength evidence was assigned for effect of four factors upon risk of acute care utilisation in final months of life; two increased risk (black ethnicity, co-morbidity {previous stroke}); two reduced risk (insurance status, presence of advance decision). The remaining were assigned moderate (two factors) and low (seven factors) strengths of evidence respectively impacting upon all domains of the model. Conclusion A myriad of inter-related factors influence acute care utilisation in nursing home residents with advanced dementia approaching end of life. Further interrogation of views of health-care proxies, professionals and other stakeholders may elucidate additional influences upon decision making process, enhancing understanding.Findings may assist in informing clinical, organisational and policy initiatives to attenuate unnecessary and burdensome transition...