Audit in practice: the referral of dying patients to palliative care

Audit should be an integral part of any palliative care service. Terminal care is a continuum of palliative care. When looking for an objective measure for referrals to a new palliative care service within a specialist cancer hospital in Ireland, patient death was used as an end point. Audits were carried out looking at inpatient deaths during two separate 8-month periods. All inpatient deaths during the study periods were noted and records compared to find those who were referred to the palliative care service before death. The first audit revealed that relatively few dying patients were referred to the newly formed palliative care team; by the time the second audit was carried out, referrals had increased. For many patients their final hospital admission was for active anti-cancer treatment and was of short duration. Data from these audits were presented on several different occasions to both nursing and medical staff. This article describes these audits in detail and highlights some of the issues raised. Audit in palliative care is discussed.