Sung Chee Boon, Johnson Christina Elizabeth, Lim Wen Kwang, Fullerton Sonia Louise
1 Department of Geriatric Medicine, Southern Health , Melbourne, Australia .
J Palliat Med. 2014 Feb;17(2):204-8. doi: 10.1089/jpm.2013.0332.
Increasing demand for palliative care unit (PCU) admissions has led to a stronger focus on discharge planning. This has resulted in shorter inpatient length of stays (LOS), and stable patients not requiring specialist palliative care services being referred for placement in residential aged care facilities (RACFs). The process of placement is time-consuming and can be distressing to patients and families, so RACF placement should only be proposed in patients whose prognosis is relatively good (i.e., weeks to months).
Our aim was to identify the outcomes of palliative care inpatients referred for residential aged care placement.
A retrospective chart audit was conducted. The patients' outcomes (discharge or death and survival time) were recorded and analyzed using SPSS statistical software. Subjects were 100 consecutive inpatients from a 30-bed PCU who had been referred for RACF placement.
Of the 100 patients referred for RACF placement 73 of 100 (73%) patients had a malignant diagnosis, whereas 27 (27%) had a noncancer diagnosis. Thirty-eight (38%) patients died before discharge, including 33 of 73 (45%) patients with cancer and 5 of 27 (13%) patients with nonmalignant conditions. In particular, 12 of 17 (71%) patients with metastatic non-small cell lung (NCSLC) cancer died before or soon after discharge.
Over one-third of all patients died before discharge to an RACF could take place. The rate of death before discharge was higher among patients who had cancer. Patients suffering from NCSLC need to be more carefully selected for placement as only one-third of these patients survived to discharge.
姑息治疗病房（PCU）入院需求的增加使得人们更加关注出院计划。这导致住院时间缩短，不需要专科姑息治疗服务的病情稳定患者被转介到老年护理机构（RACF）安置。安置过程耗时且可能让患者和家属痛苦，因此RACF安置仅应建议用于预后相对较好（即数周至数月）的患者。
我们的目的是确定被转介到老年护理机构安置的姑息治疗住院患者的结局。
进行了一项回顾性病历审核。使用SPSS统计软件记录并分析患者的结局（出院或死亡以及生存时间）。研究对象为来自一个拥有30张床位的PCU的100例连续住院患者，这些患者已被转介到RACF安置。
在100例被转介到RACF安置的患者中，100例中的73例（73%）患有恶性疾病诊断，而27例（27%）患有非癌症诊断。38例（38%）患者在出院前死亡，包括73例中的33例（45%）癌症患者和27例中的5例（13%）非恶性疾病患者。特别是，17例转移性非小细胞肺癌（NCSLC）患者中有12例（71%）在出院前或出院后不久死亡。
在所有患者中，超过三分之一在转介到RACF安置之前就已死亡。出院前死亡率在癌症患者中更高。患有NCSLC的患者在安置时需要更仔细地挑选，因为这些患者中只有三分之一存活至出院。
