Factors influencing the length of stay in the palliative care unit in patients discharged home: results from a tertiary hospital in Turkey

Authors: HİLAL ZENGİN, İLKER TAŞÇI

Abstract: Background/aim: Increased length of stay (LOS) in the palliative care unit (PCU) is a serious burden to the patients and the health care system. The predictors of longer LOS in a PCU have not been reported so far from Turkey. Our aim in this study was to evaluate the factors associated with the LOS in the PCU of a tertiary hospital. Materials and methods: This cross-sectional analysis of a retrospective cohort evaluated adult patients' medical records admitted to the PCU between 2017 and 2019. The main inclusion criteria were 4 or more days of palliative unit stay and being discharged home during the study period. Data on demographics, chronic diseases, mobilization disability, route of feeding, tracheostomy, sleep disturbances, pressure ulcers, and antidepressant use were collected. Potential factors associated with prolonged LOS tertiles were examined by ordinal regression analysis. Results: A total of 287 discharges from the PCU to home were analyzed. Mean (SD) age was 70.5 (15.8) years, and there was a male predominance (55.7%). The majority of patients had malnutrition, mobility limitation, hypertension, malignant disease, and sleep disturbances. Median LOS was 15 days (4-79). Mean age, hypertension, infections, mobilization limitation, tube feeding, permanent tracheostomy, and pressure ulcers increased from the short stay tertile (4-12 days) to the medium stay tertile (13-20 days) and long stay tertile (>21 days) of LOS. Mobilization limitation [p = 0.013, OR: 2.34 (95% CI: 1.19-4.60)], tube feeding [p = 0.001, OR: 2.63 (95% CI: 1.49-4.66)], permanent tracheostomy [p = 0.007, OR: 4.10 (95% CI: 1.48-11.36)], and hypertension diagnosis [p = 0.023, OR: 1.80, (95% CI: 1.09-2.98)] on admission were associated with being in the medium stay or long stay tertiles of LOS compared to the lowest tertile. Conclusion: A longer length of PCU stay is associated with mobilization limitation, tube feeding, permanent tracheostomy, and hypertension. We found no evidence that age, infections or pressure ulcers on admission were associated with extra LOS in the PCU in patients discharged home.

Keywords: Palliative care, home discharge, tube feeding, pressure ulcer, tracheotomy, length of stay

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