Prevalence and predictors for 72-h mortality after transfer to acute palliative care unit

Abstract

Purpose Accurate prediction of survival is important to facilitate clinical decision-making and improve quality of care at the end of life. While it is well documented that survival prediction poses a challenge for treating physicians, the need for clinically valuable predictive factors has not been met. This study aims to quantify the prevalence of patient transfer 72 h before death onto the acute palliative care unit in a tertiary care center in Switzerland, and to identify factors predictive of 72-h mortality. Methods All patients hospitalized between January and December 2020 on the acute palliative care unit of the Competence Center Palliative Care of the Department of Radiation Oncology at the University Hospital Zurich were assessed. Variables were retrieved from the electronic medical records. Univariable and multivariable logistic regressions were used to identify predictors of mortality. Results A total of 398 patients were screened, of which 188 were assessed. Every fifth patient spent less than 72 h on the acute palliative care unit before death. In multivariable logistic regression analysis, predictors for 72-h mortality after transfer were no prior palliative care consult (p = 0.011), no advance care directive (p = 0.044), lower performance status (p = 0.035), lower self-care index (p = 0.003), and lower blood albumin level (p = 0.026). Conclusion Late transfer to the acute palliative care unit is not uncommon, which can cause additional distress to patients and caretakers. Though clinically practical short-term survival predictors remain largely unidentified, early integration of palliative care should be practiced more regularly in patients with life-limiting illness.

Acute palliative care units: characteristics, activities and outcomes – scoping review

“…In another study, the mortality rate was 31% 22. Twenty per cent of patients died within 3 days after arrival on the APCU, regardless of a prior palliative care consultation 27. In Japan, 11.7% of patients died within 3 days of admission.21.…”

“…In Italy, the mean APCU stay was short, ranging 5.4–6.9 days 10 17. In some studies, a relevant amount of patients had a short length of stay as they died within 3 days 26 27. In studies performed in Arabian countries, hospital stay was much longer.…”