Accuracy of doctors' decision of fast-track discharges: a prospective audit

Introduction: With an ageing population, more people are living with terminal illness, giving opportunities to identify those with predictable shortened life expectancy. The fast-track pathway was developed to speed up funding of care for people expected to die within 12 weeks. Our aim was to investigate the accuracy of doctors’ prediction of death for patients admitted to hospital and referred to the fast-track pathway.

Methods: A prospective audit of hospitalised patients who were referred to the fast-track discharge pathway with an expected death within 12 weeks from the date of discharge. Patients were followed up to the date of death. The percentage of patients who died within 12 weeks was calculated to reflect accuracy of doctors’ prediction of death.

Results: 185 patients were referred to the fast-track pathway. Most patients, 169 (91.4%), died within 12 weeks suggesting good accuracy of doctors’ prediction with 84 (46%) dying early (within 2 weeks). Mean (SD) survival was 27.7 days (SD of 23.1) overall but was only 6.63 days (SD of 3.84) in the early death group compared to 48.1 days (SD of 46.42, P=0.001) in the late death group, suggesting that hospital admission for the patient cohort who died early may have been avoidable. Patients who died early were significantly older (P=0.003), lived in a care home (P=0.01), had more prevalent dementia (P=0.002), and presented more with sepsis (P=0.03) or acute organ failure (P=0.03) than late death group.

Conclusion: Doctors’ prediction of death and referral to fast-track discharge pathway was good. Significant numbers of patients died early suggesting avoidable hospital admissions and that fast-track care could have been delivered in community. Future research is required to explore barriers of delivering fast-track care in the community to avoid costs and improve patient experience.