[Emergency admissions from nursing homes to hospital at the end of life]

Admissions from nursing homes to hospital at the end of life have not been previously studied in Norway. The goal of this project was to document acute admissions to a Norwegian hospital for patients who died within 48 hours after hospitalization.

This study is based on information recorded in patient charts for admissions to Haraldsplass Deaconess Hospital, Bergen in the period 1.10. 2007-30.9.2008. Patients who were admitted from nursing homes and died within 48 hours after admission to the hospital were eligible for inclusion. Cooperation between nursing homes and the hospital and whether patients received appropriate palliative care was analysed.

26 patients, mean age 85.3 years, were included in the study. All of them had internal medicine problems. 12 patients had been assessed by a physician before admission. 14 patients had a written referral from a doctor and 18 patients had a note from a nurse. For eight patients no information was given about what was expected from the hospital and for four patients there was no information about medication. No documentation was available about verbal contact between the institutions before the admissions. In the hospital, diagnostic procedures were used for 24 patients and potentially life-prolonging treatment was started for 23 patients. Morphine was prescribed for 18 patients.

The results show that nursing home residents have inadequate access to physicians, and indicate that competence concerning evaluation of critically ill patients in nursing homes must be improved. Hospital physicians used a treatment focus in their patient approach. The cooperation and communication between nursing homes and the hospital functioned badly. Palliative care should be improved both in the hospital and the nursing homes.