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Table 4 24/7 out-of-hours telephone line

From: A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence

Author, date and journal Study design Sample and setting Research focus Relevant results Wider implications Limitations
Sue Ryder; 2012; Partnership for Excellence in Palliative Support (PEPS) [27] Longitudinal pilot study. PEPS is a single-point-of-access, 24-h telephone service in Bedfordshire, England, which brings together 15 organisations. A senior nurse is the first point of access. To compare information from a sample of patients with hospital activity datasets before and after registration. 1051 patients were registered. 68% who died were supported to die at home, with only 10% dying in an acute hospital. Data suggested that introduction of a single point of access service could result in 30% fewer admissions, a 30% shorter stay and a cost reduction of around £300 per admission. Pilot project.
Lustbader et al.; 2017; Journal of Palliative Medicine [39] Quantitative, retrospective, comparative analysis. 82 US Medicare Shared Savings Program accountable care organisation deceased patients compared with 596 patients receiving usual care between October 2014 and March 2016. To evaluate the impact of a home-based palliative care programme that included a 24/7 telephone line. A 34% reduction in hospital admissions during the final month of life was observed in hospital-based palliative care-enrolled patients.
Hospital-based palliative care was also linked with a reduction in emergency department visits per 1000 patients compared with standard care (878 vs. 1097).
Hospital-based palliative care in an accountable care organisation is linked with significant cost savings and fewer hospital admissions. Did not test for the individual benefits or drawbacks of a 24/7 telephone line in this setting.
Alonso-Babarro et al.; 2013; Palliative Medicine [46] Quantitative population-based comparison. 549 cancer patients in 2 areas in the Madrid region. Only 1 area had a palliative home care team. To explore the impact of palliative home care team in the last 2 months of life on place of death, emergency room visits, admissions and use of hospital resources. Frequency of patients dying in hospital was significantly lower in the palliative home care team area (61% vs. 77%, p < 0.001), as were the number of patients using emergency services (68% vs. 79%, p = 0.004) and number of patients using in-patient services (66 vs. 76%, p = 0.012). After adjusting for other factors, patients in the palliative home care team area had a lower risk of hospital death than those in the non-palliative home care team area (adjusted odds ratio 0.4, 0.2–0.6). Suggests that palliative home care team is associated with reduced in-patient deaths and use of hospital services in the last 2 months of life. Focused on 2 specific urban areas, meaning unidentified factors may influence in-patient deaths.
Ranganathan et al.; 2013; Journal of Palliative Medicine [48] Quantitative, retrospective cohort study. 391 American palliative home care patients compared with 890 palliative care patients receiving standard care at home, post-acute care programme. To study the impact of palliative home care with a 24-h telephone line on 30-day hospital readmission rates. Those enrolled in the palliative care at home programme had a 30-day readmission probability of 9.1% vs. 17.2% in those who received standard care at home. Palliative home care programmes with an out-of-hours telephone line may help reduce 30-day hospital admission rates. Did not individually test the effect of the telephone line.
The study could not adjust for
treatment intensity, which may have affected readmission.
Purdy et al.; 2015; BMJ Supportive & Palliative Care [56] Quantitative, retrospective cohort study. 3564 patients who died of end-of-life conditions in North Somerset and Somerset. 829 patients used the Delivering Choice Programme, a palliative care service with an out-of-hours telephone line, front-of- house, hospital-based, end-of-life-care discharge-in-reach nurses and end-of-life care coordination centres. To investigate the effect of the delivering choice programme on place of death and hospital utilisation. The phone line was associated with a lower risk of hospital admission during the last week of life only (OR 0.44, 95% CL 0.25–0.78, p = 0.005).
There was also a risk reduction of emergency department attendance in the last week of life linked with the phone line (OR 0.34, 95% CL 0.17–0.70, p = 0.003).
Out-of-hours telephone lines may reduce hospital utilisation close to death. No randomisation.
Did not adjust for comorbidities.
Selection bias.