“After-hours” emergencies in patients under homecare – preliminary report

Introduction
The subject of this work is a preliminary analysis of the frequency and causes of medi­cal interventions in patients under homecare.

Aim
Obtaining demographic, clinical and social characteristics of the examined group.

Material and methods
Medical records of patients under hospice homecare between January 1, 2018 and December 31, 2018 were retrospectively reviewed.

Results
167 emergency calls were made (31 managed by phone and 136 personally) in 77/339 (19.3%) patients followed (lungs 20.8%, colon: 13.0%, breast: 9.1%, others); aged 34–99 years (median: 73), women: 54.5%. In 46 (33.8%) cases the reason for personal consultation was death report, in 90 (66.2%) at least two co-existing problems, mostly: breakthrough pain (14.0%), dyspnea (10.3%), fever (8.1%); 90.3%, phone managed emergencies were aimed at modification of the pre-existing problem. The highest ratio of the number of emergencies to the duration of home hospice care in days was reported for lung, colon and central nervous system malignancies; no significant relation to age and gender. No hospital admissions were reported, 57 (74.0%) patients died at home, 9 (11.7%) were referred to hospital-based hospice and 11 (14.3%) continued homecare.

Conclusions
“After-hours” emergencies are a significant part of whole-day home hospice care. Reasons for emergencies are multifactorial with breakthrough pain, dyspnea and fever being the most frequently reported. “After-hours” emergencies managed by phone were mostly aimed at modification of the therapy for previous entities. Data we obtained are preliminary. The study will continue to improve education of caregivers for the most frequently encountered emergencies.