Dr Sarah Tan1, Laura Lunardi1, Normahdi Mohd Nor1, Arthas Flabouris2,3, Susan Crail1
1Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia, 2Intensive care unit, Royal Adelaide Hospital, Adelaide, Australia, 3University of Adelaide, Adelaide, Australia
Aim: To identify the intensity of interventions and treatment renal patients experience during their final hospital admission.
Background: Renal patients, particularly those on dialysis, are known to have high morbidity and mortality risks, and their illness trajectory often leads to death in hospital.
Methods: Utilising electronic medical records and Rapid Response Team (RRT) data, we performed an audit of the terminal admissions of renal adult inpatients who died in hospital between January 2020 to September 2021 and their final 6 months of life. We collected demographic data and treatment information regarding their final 6 months as well as escalations of care during the terminal hospital admission prior to death, including time in intensive care, RRT data and number of invasive interventions such as surgery.
Results: We identified 90 patients who died in hospital during the specified period. The majority were on haemodialysis (51/90, 56.7%) and had over 3 comorbidities (56.7%). Of those not on dialysis at presentation, 32% (8/25) were initiated on dialysis. During the final admission, 52.2% (47/90) had a RRT call, 38.9% (35/90) an intensive care stay and 54.4% (49/90) underwent an invasive intervention. In the preceding 6 months, 44.4% (40/90) had had 2 or more hospital admissions and 23.3% (21/90) attended the emergency department 4 or more times. Only 10% had an advanced care directive prior to the final admission.
Conclusion: Our audit highlights the significant treatment and intervention burdens renal patients can experience towards the end of life. Being able to identify patients with terminal trajectories may facilitate advanced care planning and avoid recurrent hospital presentations and unnecessary interventions.
Biography:
Sarah is currently undertaking advanced training in palliative care in Melbourne, having completed nephrology training in Adelaide in 2022. She has a particular interest in kidney supportive care.