Service Outcomes 6 Years After Implementing Strategies In Optimizing Bed Utilization At A Palliative Care Unit

Introduction: The population needs for palliative care service are rising. To ensure that prioritized palliative care services are provided in an integrated and sustainable way, the traditional model of hospice with emphasis on in-patient care was gradually transformed to a comprehensive model with an in-patient palliative care unit and ambulatory service. Between 2004 and 2009, seven strategies were implemented in a palliative care unit to optimize the use of in-patient beds and facilitate model shift.Methods: This was a retrospective study that examined the service outcomes after implementing strategies in a palliative care unit in Hong Kong.Results: A total of 2874 episodes of in-patient palliative care discharges and deaths occurred during the study period. The average length of stay in the unit dropped from 17.9 days in 2004 to 10.8 days in 2009 (P < 0.001). The in-patient bed occupancy rate rose from 88.9% in 2004 to 98% since 2005 (P < 0.001). There were no significant difference in the unplanned re-admission rate as defined by re-admission within 28 days (P = 0.496) and in-patient mortality rate (P = 0.453) over the study period. The out-patient attendances and palliative care coverage were also statistically significant increased over the study period.Conclusion: Our experience in operating a palliative care unit with shorter length of stay would not increase the overall unplanned re-admission and mortality rate. Shifting the model of palliative care may be possible to achieve service outcomes.