Digitally Recording Comfort Observations in the Last Days of Life

Area of Science:

• Palliative Care
• Health Informatics
• Quality Improvement

Background:

• High percentage of deaths occur within hospitals, indicating unmet needs in end-of-life care.
• Individualized care plans and specialist palliative care reviews can address these unmet needs.
• Existing care models require enhancement to improve patient comfort and support during the dying process.

Purpose of the Study:

• To implement and evaluate an electronic comfort observation (e-comfort obs) system in a large acute hospital trust.
• To assess the impact of the e-comfort obs system on the quality of end-of-life care.
• To identify benefits for patients, families, healthcare staff, and the healthcare system.

Main Methods:

• Development of an electronic comfort observation chart and individualized care plan.
• Implementation of a centralized dashboard for Specialist Palliative Care Teams (SPCT).
• Utilizing a rolling prospective audit to monitor system usage and outcomes.

Main Results:

• Over 3000 patients received care supported by e-comfort obs.
• E-comfort obs were utilized in over 72% of trust deaths in the last 3 months and 2/3 of deaths in the first 12 months.
• Seven percent of recorded observations indicated moderate to severe symptoms, enabling targeted interventions.

Conclusions:

• Electronic comfort observations can be successfully integrated into large acute trusts.
• The system demonstrates potential to enhance the quality of end-of-life care for current and future patients.
• Further development, including integration with electronic prescribing, is recommended to optimize the system.