Project PEOLC04

What circumstances lead out-of-hours clinicians to arrange hospital admissions for end-of-life patients? A systematic review of UK evidence

Systematic Literature review concerning out of hours admissions close to the end of life


Out-of-hours hospital admissions for end-of-life care patients are a common cause for concern to patients, families, clinicians and policy makers. It is unclear what issues, or combinations of issues, lead out-of-hours clinicians to initiate hospital care for these patients.

Project aims

To investigate the circumstances, processes and mechanisms of UK out-of-hours services-initiated end-of-life care hospital admissions.

Project activity 

  • Eight electronic databases were searched from inception to December 2019 supplemented by hand-searching of BJGP. Key search terms included: out-of-hours services, hospital admission and end-of-life care.
  • Two reviewers independently screened and selected papers and undertook quality appraisal using Gough’s Weight of Evidence Framework.
  • Data was analysed using narrative synthesis and reported following PRISMA Complex Intervention Guidance.

What we found and what this means

  • Searches identified 20,227 unique citations, 25 of which met the inclusion criteria.
  • Few studies had a primary focus on the review questions.
  • Admissions were instigated primarily to address clinical needs, caregiver and/or patient distress and discontinuity or unavailability of care provision and were arranged by a range of out-of-hours providers.
  • Reported frequencies of end-of-life care patients being admitted to hospital varied greatly; most evidence related to cancer patients.

Who is involved?

Principle Investigator

Professor Stephen Barclay (, University of Cambridge

Researchers and institutions

Contact us

Stephen Barclay,