Fast track discharges – Are we getting it right?

Introduction

We plan fast-track discharges when a person has limited life expectancy and is reaching end of life. When such patients are identified, we use a simple fast-track tool to minimise the delay and reduce the need for in-depth assessments and paperwork. Despite being used very widely, there is very little data in literature regarding the indications for fast-track discharges and life expectancy of patients following discharge. We conducted this observational study to answer these questions.

Methods

We collected data over a three month period from the fast-track applications focusing on indications, length of survival post discharge and what has been communicated to the families.

Results

There were 45 discharges during the three month period. The mean age was 79.6 (range 32 – 98). Most of the applications were made from the medical wards (32), especially from the care of the elderly wards, followed by surgical and the emergency quarter. 10 patients died in the hospital before their discharge could be processed. 17 patients went home, 14 went to a care home and 4 went to a community setting. 23 patients had malignancy, 11 had end organ failure, 6 had advanced dementia, 3 had stroke and 2 had fracture neck of femur. After excluding the patients who died in the hospital, the mean survival following discharge was 15.9 days (1-77 days) and 5 patients were still alive at 90 days. Evidence for good communication with families was lacking from the application forms.

Discussion

Malignancy is the most common reason for fast-track discharges. Even though many patients and families think that end of life means only days or weeks, many survive much longer. We need better documentation regarding communication with patients and families regarding diagnosis and prognosis.