Identification of Dutch hospital inpatients with possible palliative care needs: a nation-wide flash mob study

Background: Identifying hospital inpatients who are approaching the end of life is essential for providing optimal palliative care. The study aims to determine the prevalence of hospital inpatients with a potentially limited life expectancy (< 12 months) using the surprise question, and to assess the extent of specialist palliative care team (PCT) involvement in this population. Methods: On the 16^th of April 2021, we conducted a multi-center, cross-sectional, nationwide study in Dutch hospitals using a flash mob design. Nurses and physicians independently answered the surprise question (SQ) for all adult hospital inpatients: “Would you be surprised if this patient died within the next 12 months?”. If answered negatively, they were then asked to indicate if they estimated life expectancy to be less than 3 months, and whether PCTs were involved. Results: In total, 48 of 68 (70%) Dutch hospitals participated in the study. Nurses and physicians filled out 16,607 questionnaires regarding 8,768 patients. Of 8,768 patients, 80% were admitted because of non-malignant diseases. Physicians answered the SQ negatively for 2,826 (35%) patients. Physicians indicated that PCT was involved in 6% of these patients and that PCT referral was considered useful for another 6%. For patients with an estimated life expectancy < 3 months (n=582), these proportions increased to 15% and 13%, respectively. Conclusions : A third of all hospital inpatients had a possible life-limiting condition and may benefit from palliative care and advance care planning. Future studies should focus on exploring the palliative care needs of hospital inpatients and possible benefits of timely implementation of palliative care.