Healthcare professionals' perspectives of the management of people with palliative care needs in the emergency department of a UK hospital.

BACKGROUND: The Emergency Department (ED) is not always the optimal place for people with palliative care needs but is the most common route for treatment when urgent care is sought. The aim of this study,''REasons for PalLIative Care Admissions (REPLICA)' was to explore the perspectives of ED healthcare professionals of hospital admission or discharge via ED for palliative care patients. METHODS: This is a sequential mixed methods study comprising (i) quantitative descriptive analysis of Hospital Episode Statistics (HES) of palliative care patients (code Z51.5) who were admitted through ED in a West Midlands Hospital and for the rest of England; (ii) in-depth semi-structured interviews with 17 ED staff which were analysed using thematic content analysis. RESULTS: Over the four years (2013-2017), 430,116 people admitted through ED were identified with a Z51.5 diagnosis code, 0.6% (n = 2736) of whom were from the West Midlands Hospital. The most common reasons for palliative care patients' admission to hospitals across England were for care of chronic kidney disease, cancers and urinary tract infections. Five themes were elicited from the qualitative analysis: (1) Providing palliative care in ED is challenging, due to factors including lack of training in palliative care and the unsuitable environment. (2) Patients go to ED due to challenges in community management such as inappropriate referrals and no care plan in place. (3) Health system influences admission and discharge decisions, including bed availability and being unable to set up community services out-of-hours. (4) Discussion with patient about treatment and end of life care needs to be outside of ED whilst the patient is still well enough to express their wishes. (5) Improving services for patients with palliative care needs. Recommendations include short training sessions for ED staff and accessing palliative care professionals 24/7. CONCLUSIONS: A large number of palliative care patients visit ED and are admitted to hospital for care; there is an urgent need to prevent patients attending the hospital through the establishment of a coordinated and dedicated service to support palliative care patients in the community.

Comparative study of operative expenses: robotic vs. laparoscopic vs. open liver resections at a university hospital in the UK.

Robotic liver resections (RLR) are increasingly being performed and has previously been considered more costly. The aim is to explore the cost of RLR compared with laparoscopic and open liver resection in a single National Health Service (NHS) hospital. A retrospective review of patients who underwent RLR, LLR, and OLR from April 2014 to December 2022 was conducted. The primary outcomes were the cost of consumables and median income, and the secondary outcomes were the overall length of stay and mortality at 90 days. Overall, 332 patients underwent liver resections. There were 204 males (61.4%) and 128 females (38.6%), with a median age of 62 years (IQR: 51-77 years). Of these, 60 patients (18.1%) underwent RLR, 21 patients (6.3%) underwent LLR, and 251 patients (75.6%) underwent OLR. Median consumables cost per case was £3863 (IQR: £3458-£5061) for RLR, £4326 (IQR: £4273-£4473) for LLR, and £4,084 (IQR: £3799-£5549) for the OLR cohort (p = 0.140). Median income per case was £7999 (IQR: £4509-£10,777) for RLR, £7497 (IQR: £2407-£14,576) for LLR, and £7493 (IQR: £2542-£14,121) for OLR. The median length of stay (LOS) for RLR was 3 days (IQR: 2-4.7 days) compared to 5 days for LLR (IQR: 4.5-7 days) and 6 days for OLR (IQR: 5-8 days, p < 0.001). Within the NHS, RLR has consumable costs comparable to OLR and LLR. It is also linked with a shorter LOS and generates similar income for patients undergoing OLR and LLR.