Dying in Australian hospitals: will a separate national clinical standard improve the delivery of quality care?
Katherine Clark A B D , Aileen Collier C and David C. Currow CA Department of Palliative Care, Calvary Mater Newcastle, Edith Street, Waratah, NSW 2298, Australia.
B The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
C Discipline, Supportive and Palliative Care, Flinders University, Bedford Park, Adelaide, SA 5041, Australia. Email: aileen.collier@flinders.edu.au; david.currow@health.sa.gov.au
D Corresponding author. Email: katherine.clark@calvarymater.org.au
Australian Health Review 39(2) 202-204 https://doi.org/10.1071/AH14175
Submitted: 2 October 2014 Accepted: 19 October 2014 Published: 17 December 2014
Abstract
While it is commonly stated that for most people the preferred place of death is their own homes, the actual reality is that most people will die in hospitals. This is both by choice and necessity. However, for many, the care that they receive would not necessarily align with their expectations. The need to improve the quality of health care at the end of life has been acknowledged by the Australian Commission for Safety and Quality in Healthcare with the release of a recent discussion paper. It is presumed this is a prelude to the release of another quality standard specifically for end of life care. The aim of this paper is to question whether such a standard is likely to result in the hoped for improvements in care.
What is known about the topic? Numerous reports highlight that the care received by people dying predictably in hospital would not always be considered of sufficient quality to reliably and safely address their needs. As the numbers of people dying in Australian hospitals is likely to exponentially rise over the next decade there is a real need to address this care gap.
What does this paper add? The need to address this care gaps has been highlighted by the Australian Commission for Safety and Quality in Healthcare. While this focus is welcomed, this paper questions whether any changes can be made without considering the fundamental issues precluding the delivery of quality health care as would be expected by any other patient cohort.
What are the implications for practitioners? As with care at any point, patients and their families expect care to be delivered in a quality paradigm: patient-centred, evidence-based and safe. Care at the end of life is no different.
References
[1] Australian Institute of Health and Welfare (AIHW). Palliative care services in Australia 2012. Sydney: AIHW; 2012.[2] Australian Institute of Health and Welfare. Causes of death. 2013. Available at: http://www.aihw.gov.au/deaths/causes-of-death [verified 10 August 2014].
[3] Swerissen H, Duckett S. Dying well. Melbourne: The Gratten Institute; 2014.
[4] To T, Green A, Agar M, Currow DC. A point prevalence survey of hospital inpatients to define the proportion with palliation as the primary goal of care and the need for specialist palliative care. J Intern Med 2011; 41 430–3.
| A point prevalence survey of hospital inpatients to define the proportion with palliation as the primary goal of care and the need for specialist palliative care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MrksVyjuw%3D%3D&md5=c0833b133ec4d22f82b6a974fb019240CAS |
[5] Gott M, Frey R, Raphael D, O’Callaghan A, Robinson J, Boyd M. Palliative care need and management in the acute hospital setting: a consensus of one New Zealand hospital. BMC Palliat Care 2013; 12 15
| Palliative care need and management in the acute hospital setting: a consensus of one New Zealand hospital.Crossref | GoogleScholarGoogle Scholar | 23537092PubMed |
[6] Clark D, Armstrong M, Allan A, Graham F, Carnon A, Isles C. Imminence of death among hospital inpatients: prevalent cohort study. Palliat Med 2014; 28 474–79.
| Imminence of death among hospital inpatients: prevalent cohort study.Crossref | GoogleScholarGoogle Scholar | 24637342PubMed |
[7] Agar M, Currow DC, Shelby-James TM, Plummer J, Sanderson C, Abernethy AP. Preference for place of care and place of death in palliative care: are these different questions? Palliat Med 2008; 22 787–95.
| Preference for place of care and place of death in palliative care: are these different questions?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cnksVyqtA%3D%3D&md5=65e3c335ec0debe8d212df12e0391f7cCAS | 18755830PubMed |
[8] Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ 2006; 332 515–21.
| Factors influencing death at home in terminally ill patients with cancer: systematic review.Crossref | GoogleScholarGoogle Scholar | 16467346PubMed |
[9] Clark K, Byfieldt N, Green M, Lack J, Saul P, Philips J. Would usual care in of the dying in acute hospitals meet national Australian quality standards? Aust Health Care Rev 2014; 38 223–9.
[10] Australian Commission for Safety and Quality in Healthcare (ACSQHC). Safety and quality of end-of-life care in acute hospitals: a background paper. Sydney: ACSQHC; 2013.
[11] Anon. National consensus statement: essential elements for safe and high-quality end-of-life care in acute hospitals. Consultation draft. 2014. Available at: http://www.safetyandquality.gov.au [verified 10 August 2014].
[12] Australian Commission for Safety and Quality in Healthcare (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2011.
[13] Kennedy C, Brooks-Young P, Brunton C, Larkin P, Connolly M, Wilde-Larsson B, Larsson M, Smith T, Chater S. Diagnosing dying: an integrative literature review. BMJ Support Palliat Care 2014; 4 263–70.
| Diagnosing dying: an integrative literature review.Crossref | GoogleScholarGoogle Scholar | 24780536PubMed |
[14] Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med 2007; 167 453–60.
| Efficacy of communication skills training for giving bad news and discussing transitions to palliative care.Crossref | GoogleScholarGoogle Scholar | 17353492PubMed |
[15] Quill TE, Abernethy AP. Generalist plus specialist palliative care: creating a more sustainable model. N Engl J Med 2013; 368 1173–5.
| Generalist plus specialist palliative care: creating a more sustainable model.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXlt1Sqsro%3D&md5=479c39857addec166c642abacf4f1121CAS | 23465068PubMed |
[16] Gott M. Avoidable for whom? Hospital use at the end of life. Palliat Med 2014; 28 917–8.
| Avoidable for whom? Hospital use at the end of life.Crossref | GoogleScholarGoogle Scholar | 24904020PubMed |
