Understanding end-of-life care in Australian hospitals

Area of Science:

• Gerontology
• Palliative Care
• Health Services Research

Background:

• The majority of Australian patient deaths occur in hospitals.
• Hospital care must align with the National Consensus Statement for safe, high-quality end-of-life care.
• Existing research highlights a need for improved end-of-life care practices in Australian hospitals.

Purpose of the Study:

• To investigate end-of-life care practices in ward and intensive care unit (ICU) settings across nine Australian hospitals.
• To analyze patient demographics, advance care plans, life-sustaining treatments, recognition of dying, and palliative care approaches.
• To identify gaps in care and alignment with national standards.

Main Methods:

• Retrospective observational study of 1693 in-hospital deaths (356 in ICU).
• Review of patient records including demographics, advance care plans, and treatments.
• Analysis of clinician recognition of dying and palliative care referrals.

Main Results:

• Only 12% of patients had an end-of-life care plan on admission.
• 82% of patients were recognized as dying, but often within 48 hours of death.
• 41% were referred for palliative care, mostly in the final days, with 62% receiving active interventions in their last 48 hours.

Conclusions:

• Late recognition of dying negatively impacts timely palliative care and patient experience.
• There is a significant misalignment with the National Consensus Statement for end-of-life care.
• A nationally coordinated strategy is essential to enhance end-of-life care quality and patient outcomes.