Hospital admissions at the end of life: reasons, appropriateness and avoidability (FLIECE).
The acute hospital setting consistently remains a frequent place of death in most high-income countries; in Belgium nearly half of all deaths occur in the hospital setting. To reduce the number of hospital deaths there has been an increased interest in reducing the number of end-of-life hospital admissions. The present dissertation aims to shed some light on the complexity of the reasons for and circumstances leading to such admissions and to provide a more thorough understanding about the appropriateness and avoidability of these admissions.
In a first part, the proportion of older persons with a dementia-related disease who die in hospital in Belgium is examined, using death certificate data. In a second part family physicians’ perspectives are explored concerning their role in preventing and guiding end-of-life hospital admissions and the difficulties they experience, using a focus group methodology. In a third part, the reasons, appropriateness and avoidability of end-of-life hospital admissions are explored, using a mixed method approach: focus groups among family physicians and nurses from different care settings (home care, care home and hospital); interviews with family carers whose relative had died in hospital; and surveys among family physicians whose patients had died non-suddenly in the acute hospital setting of a university hospital.
Although the acute hospital setting is considered not to be an ideal setting for end-of-life care or as a place of death, most terminal hospital admissions might be considered appropriate or unavoidable, either due to a medical complication (e.g. pneumonia), the patients’ preferences or because of an inadequate care setting. Further implications for policy and practice that could reduce the number of end-of-life hospital admissions are provided in this dissertation.