End-of-life care in hospital: an audit of care against Australian national guidelines
Melissa J. Bloomer
A B C E , Alison M. Hutchinson A B D and Mari Botti A B C
A Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. Email: alison.hutchinson@deakin.edu.au; mari.botti@deakin.edu.au
B Centre for Quality and Patient Safety Research, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
C Epworth Deakin Centre for Clinical Nursing Research, Richmond, Vic. 3121, Australia.
D Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Clayton, Vic. 3168, Australia.
E Corresponding author. Email: m.bloomer@deakin.edu.au
Australian Health Review 43(5) 578-584 https://doi.org/10.1071/AH18215
Submitted: 7 August 2018 Accepted: 14 December 2018 Published: 5 March 2019
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care.
Methods A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC’s Elements 1–5 were used to evaluate end-of-life care.
Results Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001).
Conclusion There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC’s Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care.
What is known about the topic? Acute care settings provide the majority of end-of-life care. Despite the ACSQHC’s Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations.
What does this paper add? There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity.
What are the implications for practitioners? The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care.
Additional keywords: care pathway, communication, death, decision-making, dying, family care, goals of care, palliative care, pastoral care, treatment limitation.
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