CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
http://ahha.asn.au/
  Journal of the Australian Healthcare & Hospitals Association
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Structure
Contacts
For Advertisers
Content
Online Early
Current Issue
Just Accepted
All Issues
Research Fronts
Sample Issue
For Authors
General Information
Author Instructions
Submit Article
Scope
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates
Library Recommendation

ANZ Health Policy

Open access content from the Australia and New Zealand Health Policy journal is now available.


blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image
facebook  

red arrow Connect with AHHA
blank image
facebook TwitterIcon

red arrow Connect with CP
blank image
facebook twitter logo LinkedIn

 

Article << Previous     |     Next >>   Contents Vol 38(2)

Dying in two acute hospitals: would usual care meet Australian national clinical standards?

Katherine Clark A B F, Naomi Byfieldt A, Malcolm Green A, Peter Saul D, Jill Lack D and Jane L. Philips E

A Department of Palliative Care, Calvary Mater Newcastle, Edith Street, Waratah, NSW 2298, Australia.
B School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia.
C Clinical Excellence Commission, NSW Department of Health, 227 Elizabeth Street, Sydney, NSW 2000, Australia.
D Cancer Decorate, The Lodge, John Hunter Hospital Campus, Locked Bag 1, HRMC, NSW 2310, Australia.
E The University of Notre Dame Australia, 170 Darlinghurst Street, Darlinghurst, NSW 2010, Australia.
F Corresponding author. Email: katherine.clark@calvarymater.org.au

Australian Health Review 38(2) 223-229 http://dx.doi.org/10.1071/AH13174
Submitted: 17 September 2013  Accepted: 27 November 2013   Published: 4 March 2014


 
PDF (129 KB) $25
 Export Citation
 Print
  
Abstract

The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering people’s wishes while always treating people with dignity and respect.

This work describes a gap analysis undertaken to explore if issues defined as important by people facing imminent death would have been addressed by usual care of the dying in general hospital wards. The specific issues examined included the documentation that was available to define that this person was likely to die soon and how engaged the person dying seemed to be in discussions, how the person was monitored to ensure distressing symptoms were addressed when necessary and what investigations were considered necessary after the time the person was identified as dying.

Although retrospective, the review highlights that usual care would not meet people’s wishes, suggesting that care of the dying would not meet the ACQSHC standard entitled ‘Partnering with consumers’. An alternative model is needed.

What is known about the topic? The majority of Australians die in acute hospitals. Despite this, there is no agreed Australian evidence-based, clinical standard to define best practice as to what constitutes quality care for these people.

What does this paper add? This paper explores whether particular specific patient-centred needs defined in the end of life literature would have been meet by usual care delivered to people dying in general medical and surgical wards.

What are the implications for practitioners? Although many Australians would prefer a home death, the majority of deaths still occur in hospital. In this context, this work articulates that there is a need to consider the wishes and needs of patients when considering care at the end of life in line with Australian standards. However, this is only one aspect of care and further work is needed to consider other aspects of care including the quality of prescribing for dying people.

Additional keywords: death, patient-centered care.


References

[1]  King B, Kerr R, Walker A. Care for the dying in NSW. Sydney: Clinical Excellence Commission; 2013.

[2]  Australian Bureau of Statistics (ABS). Causes of death in Australia 2010. Canberra: ABS; 2012.

[3]  Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2011.

[4]  Neuberger J, Aaronovitch D, Bonser T, Charlesworth-Smith D, Cox D, Guthrie C et al. Independent review of the Liverpool Care pathway. More care, less pathway: a review of the Liverpool care pathway. London: United Kingdom Department of Health; 2013.

[5]  Phillips JL, Halcomb EJ, Davidson PM. End-of-life care pathways in acute and hospice care: an integrative review. J Pain Symptom Manage 2011; 41: 940–55.
CrossRef | PubMed |

[6]  Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev 2010; 6: CD008006.
CrossRef |

[7]  Costantini M, Ottonelli S, Canavacci L, Pellegrini F, Beccar M. The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial. BMC Health Serv Res 2011; 11: 13.
| PubMed |

[8]  Currow DC, Abernethy AP. Lessons from the Liverpool Care Pathway - evidence is key. Lancet 2013; : .
CrossRef | PubMed |

[9]  Australian Commission on Safety and Quality in Health Care (ACSQHC). Patient-centred care: improving quality and safety through partnerships with patients and consumers. Sydney: ACSQHC; 2011.

[10]  Jennings B, Morrisey MB. Health care costs in end-of-life and palliative care: the quest for ethical reform. J Soc Work End Life Palliat Care 2011; 7: 300–17.
CrossRef | PubMed |

[11]  Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 2000; 284: 2476–82.
CrossRef | CAS | PubMed |

[12]  Tulsky JA, Chesney MA, Lo B. How do medical residents discuss resuscitation with patients? J Gen Intern Med 1995; 10: 436–42.
CrossRef | CAS | PubMed |

[13]  Maguire P, Faulkner A, Booth K, Elliott C, Hillier V. Helping cancer patients disclose their concerns. Eur J Cancer 1996; 32: 78–81.
CrossRef |

[14]  Payne SA, Langley-Evans A, Hillier R. Perceptions of a ‘good’ death: a comparative study of the views of hospice staff and patients. Palliat Med 1996; 10: 307–12.
CrossRef | CAS | PubMed |

[15]  Quill TE. Perspectives on care at the close of life: initiating end-of-life discussions with seriously ill patients: addressing the ‘elephant in the room’. JAMA 2000; 284: 2502–7.
CrossRef | CAS | PubMed |

[16]  Kehl KA. Moving toward peace: an analysis of the concept of a good death. Am J Hosp Palliat Care 2006; 23: 277–86.
CrossRef | PubMed |

[17]  Dev S, Abernethy AP, Rogers JG, O’Connor CM. Preferences of people with advanced heart failure - a structured narrative literature review to inform decision making in the palliative care setting. Am Heart J 2012; 164: 313–9.
CrossRef | PubMed |

[18]  Needham DM, Scales DC, Laupacis A, Pronovost PJ. A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. J Crit Care 2005; 20: 12–9.
CrossRef | PubMed |

[19]  Therapeutic Guidelines Ltd. Australian palliative care therapeutic guidelines. Melbourne: Therapeutic Guidelines Ltd; 2010.

[20]  Back I. Palliative Medicine Handbook Online Edition. 2009. Available at http://book.pallcare.info/index.php?op=plugin&src=opiconv [verified 20 december 2013]

[21]  Zegers M, de Bruijne MC, Spreeuwenberg P, Wagner C, Groenewegen PP, van der Wal G. Quality of patient record keeping: an indicator of the quality of care? BMJ Qual Saf 2011; 20: 314–8.
CrossRef | PubMed |

[22]  Adam J. ABC of palliative care: the last 48 hours. BMJ 1997; 315: 1600–3.
CrossRef | CAS | PubMed |

[23]  Lindqvist O, Lundquist G, Dickman A. Lindqvist O, Lundquist G, Dickman A. Four essential drugs needed for quality care of the dying: A Delphi-study based international expert consensus opinion. J Palliat Med 2013; 16: 38–43.
| PubMed |

[24]  Palliative care services in Australia 2012: Australian Institute of Health and Welfare 2012.

[25]  Australian Government Department of Health. Pathology Services. Canberra: Australian Government Department of Health; 2013. Available at: http://www9.health.gov.au/mbs/search.cfm?q=65070&sopt=I [verified 20 December 2013]

[26]  Hillman KM. End-of-life care in acute hospitals. Aust Health Rev 2011; 35: 176–7.
| PubMed |


   
Subscriber Login
Username:
Password:  

 


    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2016