Use of a structured palliative care summary in patients with established cancer is associated with reduced hospital admissions by out-of-hours general practitioners in Grampian

Objectives Palliative care summaries are
used by general practices to provide
structured anticipatory care information to
those providing care during the out-ofhours
period. We hypothesised that the
availability of a palliative care summary for
individuals with established cancer would
influence emergency hospital admission
during the out-of-hours period.
Methods Each consultation with Grampian
Medical Emergency Department (GMED) is
recorded on the ADASTRA software system
and the nature of the consultation is Read
coded.We retrospectively reviewed
consultations between 1 January 2011 and
31 December 2011 which had been coded as
‘neoplasm’ or ‘terminal care’. The availability
of a palliative care summary on ADASTRA
and admission status were recorded. χ2 Test
of association was performed. Binary logistic
regression was used for multivariate analysis
exploring the effect of a palliative care
summary on admission, while adjusting for
important confounders.
Results 401 patients with established cancer
were identified who had presented to
GMED in 2011. 35.7% had a palliative care
summary available on ADASTRA. Of the
401 contacts, 100 patients were admitted to
hospital. Not having a palliative care
summary made admission significantly more
likely; χ2=12.480, p=0.001. (OR 2.425,
95% CI 1.412 to 4.165).
Conclusions Availability of a structured
palliative care plan can aid decision making
in the out-of-hours period and prevent
unplanned hospital admissions.