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Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

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When death is imminent - documenting end-of-life decisions.

Amanda Gaw¹, Steven Doherty, Philip Hungerford

¹University Department of Rural Health & Rural Clinical School, University of Newcastle, Tamworth, New South Wales. mandy.gaw@hnehealth.nsw.gov.au

Australian Family Physician

|November 13, 2012

Summary

Advance care planning discussions often occur too late, with most patients lacking documented end-of-life preferences before hospital discharge or imminent death. This highlights a critical gap in proactive end-of-life care communication.

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Area of Science:

Geriatric Medicine
Palliative Care
Healthcare Management

Background:

Growing elderly population necessitates proactive advance care planning.
Increasing emphasis on patient autonomy and self-determination in healthcare decisions.

Purpose of the Study:

To evaluate the documentation and timing of advance care planning discussions in elderly patients.
To assess the integration of patient preferences into end-of-life care within hospital settings.

Main Methods:

Retrospective review of medical records for deceased hospital patients.
Analysis of emergency department admissions for patients aged 75 and older.
Examination of documented end-of-life discussions and advance care plans.

Main Results:

77% of deceased patients had initial end-of-life discussions within 3 days of death.
82% of elderly emergency department admissions lacked documented end-of-life discussions by discharge.
Only two patients had advance care plans documented prior to emergency department admission.

Conclusions:

Documented advance care plans are infrequently prepared or communicated to acute care facilities.
End-of-life care preferences are often documented only when death is imminent.
Significant gap exists in timely and documented advance care planning for elderly patients.