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Avoidability of hospitalisations at the end of life; a model for community nurses and GPs.

Korte-Verhoef, M.C. de, Pasman, H.R.W., Schweitzer, B.P.M., Francke, A.L., Onwuteaka-Philipsen, B.D., Deliens, L. Avoidability of hospitalisations at the end of life; a model for community nurses and GPs. Journal of Advanced Nursing: 2016, 72(suppl. 1) . Abstract. 5th European Nursing Congress: 'Caring for older people: how can we do the right things right?' 4-7 oktober 2016, Rotterdam.
Background and introduction
Although many patients prefer to stay and die at home at the end of life, many are hospitalised. For hospitalised patients with a short life expectancy, it has been estimated that a quarter of hospitalisations could have been avoided. Little is known about how to avoid hospitalisations for patients living at home.

Aim
The aim of the study was to develop a conceptual model for community nurses and general practitioners (GPs) of strategies for avoiding hospitalisation at the end of life for patients living at home. The research question was how hospitalisation at the end of life can be avoided, from the perspective of community nurses, family carers and GPs?

Materials and methods
A qualitative design with in-depth interviews was used. Taking 30 cases of patients who died non-suddenly 15 community nurses, 18 family carers and 26 GPs were interviewed in depth. Of the 30 patients, 20 were hospitalised and 10 were not hospitalised in the last 3 months of life. The interview transcripts were analyzed using thematic analysis and a conceptual model was constructed based on the resulting themes.

Results
We developed a model with five key strategies that could help avoid hospitalisation at the end of life. The key strategies were:
1) marking the approach of death, and shifting the mindset;
2) being able to provide acute treatment and care at home;
3) anticipatory discussions and interventions to deal with expected severe problems;
4) guiding and monitoring the patient and family in a holistic way through the illness trajectory;
5) continuity of treatment and care at home.
If these five key strategies are followed in an interrelated way, this could help avoid hospitalisations, according to community nurses, family carers and GPs.

Conclusion
The merit of the model is that it offers insight in providing palliative care at home by community nurses and GPs and helps them to avoid hospitalisation at the end of life. It is recommended that for all patients residing at home community nurses and GPs work together as a team from the moment that it is marked that death is approaching up to the end of life.