Background Leeds Teaching Hospitals Trust (LTHT) is a flagship trust for the National End of Life Care (EoLC) strategy. Key areas of improvement in EoLC have been identified, including identification of people approaching end of life and communication of this to the individual, family and primary care colleagues.
The Gold Standards Framework is a national systematic evidence based approach to optimising EoLC. This retrospective study reviewed all deaths during in-patient stay and within 28 days of discharge from respiratory medicine.
Methods All in-patient deaths or deaths within 28 days of discharge from hospital under the care of a respiratory physician at LTHT between April and September 2011 were reviewed. All communication with primary care in the preceding 12 months was reviewed.
Results 144 individuals died on respiratory wards, median (range) age of 76 (18–96) years with the majority having a length of stay over 8 days. 42 individuals died within 28 days of discharge from a respiratory ward, median (range) age of 71 (42–87) years. The commonest cause of death was pneumonia and lung malignancy for in-patient and post-discharge deaths respectively. 23.8% and 83% of in-patient and post-discharge deaths respectively had documented communication with primary care about a palliative intent to care, the majority of these had a diagnosis of thoracic malignancy. Within the 12 months pre-death all patients had evidence that EoLC may have been appropriate to consider.
Conclusions Palliative communication with primary care was made for some individuals, mostly with lung malignancy. This probably reflects more predictable disease trajectory and MDT decisions of “best supportive care”. Lack of confidence around predicting terminal disease in other respiratory conditions, particularly those such as COPD which are prone to exacerbations, may account for the differences in rates of communication of palliative care approaches in these disease groups.
A key driver for the implementation of high quality EoLC for patients with respiratory disease is recognition of patients approaching the end of life and communication with the individual, family and primary care to ensure that the patient’s wishes for EoLC are identified and supported.
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