Transcript MORTALITY AUDIT
MORTALITY AUDIT
Dr S Callin SpR Palliative Medicine Dr L Russon Consultant Palliative Medicine BRI Palliative Care Team
Background
Sunday Times league table – hospitals judged by death rates Mortality group (BRI): Why are patients dying in hospital?
Why are patients with terminal illnesses dying in hospital? Are we planning appropriately for dying patients?
Preferred place of care
Aims of the audit
Identify reasons why patients with terminal illnesses die in hospital Improve system to reduce numbers of patients with terminal illnesses dying inappropriately in hospital
Methods
Patient sample: patients referred to the hospital palliative care team oncology ward Haematology ward 3/12 audit of all deaths Retrospective review of the notes within one week of death Interview with a member of the treating team within one week of death
Data Collection
Duration of admission Palliative Care Team involvement Liverpool Care Pathway for the Dying Preferred place of care Reason for death Unexpected death Deterioration before able to plan discharge Deterioration before planned discharge Clearly stated wish to remain in hospital Awaiting hospice bed Other
Results
54 deaths 22 oncology 9 haematology 23 other wards 57% female Median age 72 (Range 34-91) 6% non malignant
Results
Duration of admission Median 12 days (range 1-59) PCT involvement 56% of all deaths audited oncology ward (6/22) haematology ward (1/9) Duration of PCT involvement Median 7 days (0-30)
Results
Reason for death in hospital 3 3 4 Deterioration before able to plan discharge Deterioration before planned discharge Unexpected death 5 32 7
Results
Most common reason for death in hospital: ‘deterioration before able to plan discharge’ (n=32) But 13/32 patients had been in hospital for more than two weeks 1 patient was an inpatient for 30 days, 1 for 50 days and 1 for 51 days
Liverpool Care Pathway (LCP)
37% of all deaths audited on the LCP oncology deaths (14/22) haematology deaths (3/9) other wards (3/23) 0% non malignant cases 13/32 patients where deterioration was perceived to be before able to plan discharge were on the LCP
Preferred place of care
Documented preferred place of care Not documented 37 Hospital 4 Home/hospice 13
Conclusions
Almost 2/3 of cancer patients/patients referred to the PCT died in hospital because the treating team perceived they deteriorated before able to plan discharge But over 1/3 of those patients were in hospital for >2weeks Is the dying phase being recognised early enough?
… and over 1/3 were on the LCP Should preferred place of care be explored earlier with patients?
Conclusions
Need to be more proactive in diagnosing and planning care for terminally ill patients